title: 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.affiliation: 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
authors.forename: Zeev
authors.initials: Z
authors.lastname: Blumenfeld
authors.forename: Michael
authors.initials: M
authors.lastname: von Wolff
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D003276:Contraceptives, Oral; D007987:Gonadotropin-Releasing Hormone