GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy.

Abstract

BACKGROUND:

For preserving fertility in women during chemotherapy, the character of invasive techniques, such as ovarian cryopreservation and other techniques, await further experience. Meanwhile, non-invasive techniques have attempted to minimize the gonadotoxic effect of chemotherapy, by using gonadotrophin-releasing hormone-analogues (GnRH-a) or oral contraceptives (OC).

METHODS:

We performed a computerized MEDLINE search to identify articles published on fertility preservation using GnRH-a or OCs.

RESULTS:

Nine human-controlled studies reported the use of GnRH-a and four reported the use of OCs in parallel to chemotherapy. All nine studies analysing the effect of GnRH-a found lower rates of premature ovarian failure (POF) in patients receiving GnRH-a compared with the controls. Summarizing the studies resulted in 11.1% incidence of POF in patients who received GnRH-a compared with 55.5% incidence in the controls. Evidence using the fertility preserving effect of OC is limited. Two studies showed lower POF rates in OC-treated patients. The summarized data revealed a POF rate of 13.2% in patients who received OCs compared with that of 29.8% in the controls.

CONCLUSIONS:

The published clinical studies provide evidence, but do not prove statistically, that GnRH-a co-treatment reduces gonadotoxicity. Owing to the retrospective and non-randomized nature of most of the studies, definite conclusions concerning the reduction of POF by GnRH-a can still not be unequivocally drawn. As GnRH-a and OC have no serious side effects and as GnRH-a can even reduce chemotherapy-induced complications, such as severe menometrorrhagia, GnRH-a are considered by many clinicians as a clinically useful co-treatment in chemotherapy. The published clinical studies on OC also suggest a possible effect on the reduction of POF under certain conditions.

• Authors: Zeev Blumenfeld, Michael von Wolff
• Journal: Human reproduction update (Hum Reprod Update) 2008 Nov-Dec Vol. 14 Issue 6 Pg. 543-52 ISSN: 1460-2369 [Electronic] England
• PMID: 18824495 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Antineoplastic Agents
• Contraceptives, Oral
• Gonadotropin-Releasing Hormone

Topics

• Adolescent
• Adult
• Antineoplastic Agents (adverse effects)
• Breast Neoplasms (drug therapy)
• Contraceptives, Oral (therapeutic use)
• Female
• Gonadotropin-Releasing Hormone (analogs & derivatives, antagonists & inhibitors, therapeutic use)
• Humans
• Infertility, Female (chemically induced, prevention & control)
• Menstruation Disturbances (chemically induced, prevention & control)
• Primary Ovarian Insufficiency (chemically induced, prevention & control)
• Randomized Controlled Trials as Topic