GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data

Abstract

The effectiveness of GnRH agonists as fertility-preserving agents is debatable. A thorough literature search has found insufficient evidence to show that GnRH agonist co-treatment is effective in protecting the ovary from the damage of chemotherapy. A large randomized controlled trial with adequate follow-up is needed.

Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?

“…They are administered in the form of depot injections for the duration of chemotherapy. The idea is that this downregulates ovarian function with the result that the ovules will react less sensitively to radiotherapy or chemotherapy [30,31]. However, this method cannot be considered the method of choice for fertility preservation as damage to the ovaries including primary ovarian failure can occur despite downregulation [32].…”

Pharmacological options for the protection of ovarian function in patients undergoing chemotherapy

“…32 They may also affect molecules, such as transforming growth factor beta (TGF-β). 33 Other growth factors in the TGF-β superfamily may also be influenced by GnRH analogues. However, the complex interaction of all these growth factors is difficult to measure and control in an experimental model.…”

“…33 The authors argue that on the basis of the current evidence, it is possible to draw the wrong conclusions. There are many drawbacks to the published studies, which are summarised in Table I.…”

Survivorship in Hodgkin Lymphoma

“…Interestingly, concomitant use of alkylating agents or pelvic radiation can have protective effects against development of breast cancer, thought to be related to decreased estrogen production induced by treatmentrelated ovarian suppression or premature ovarian failure. [54] If efforts at fertility preservation with administration of gonadotropin releasing hormone agonists prove successful, as may be the case in breast cancer therapy [55], it is possible this benefit may be either abrogated or nullified. [56] The optimal surveillance strategy for patients placed at increased risk for breast cancer by their HL therapy remains a subject of investigation, but standards of care are beginning to emerge.…”

“…Recent research into ovarian suppression with gonadotropin releasing hormone agonists prior to initiation of chemotherapy has shown promise, with a recent large randomized clinical trial in women with breast cancer showing a statistically significant decrease in rates of amenorrhea 12 months after completion of adjuvant therapy from 26% to 9%. [55] More definitive efforts at preservation of female fertility include cryopreservation of fertilized embryos or, more recently, unfertilized ova elective oophorectomy with cryopreservation and re-implantation after therapy; and transposition of the ovary outside of pelvic radiotherapy fields. [56] For the survivor of HL, however, pre-treatment fertility preservation is something that was, or was not, done, and there are no established interventions to promote or restore fertility in the post-treatment setting.…”