GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy.
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.
Blumenfeld
Zeev
Z
Reproductive Endocrinology and Infertility Section, Department of Obstetrics and Gynaecology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel. bzeev@techunix.technion.ac.il
von Wolff
Michael
M
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced / Q000517:prevention & control*; D008599:Menstruation Disturbances / Q000139:chemically induced / Q000517:prevention & control; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents; D003276:Contraceptives, Oral; D007987:Gonadotropin-Releasing Hormone