title: Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine whether gonadotropin-releasing hormone (GnRH) analog cotreatment with chemotherapy provides better reproductive outcomes for women at risk of premature ovarian failure (POF) as a side-effect of gonadotoxic chemotherapy.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  University-affiliated research centers.
  
  
  METHODS
  None.
  
  
  METHODS
  Electronic and manual searches (e.g., MEDLINE, EMBASE, CENTRAL) up to January 2010 were performed to identify randomized controlled trials (RCTs) comparing GnRH cotreatment with chemotherapy alone in premenopausal women.
  
  
  METHODS
  Incidence of POF after treatment, incidence of women with resumption of ovulation, POF after an initial normal cycle, normal cycles but abnormal markers of ovarian reserve, spontaneous occurrence of pregnancy after treatment, and time to reestablishment of menstruation; data also extracted to allow for an intention-to-treat analysis.
  
  
  RESULTS
  Twenty-eight RCTs were identified, but only six met the inclusion criteria. Data were only available for the incidence of women with new onset of POF, resumption of ovulation, and occurrence of pregnancy. The incidence of POF or resumption of ovulation both demonstrated a statistically significant difference in favor of the GnRH cotreatment. The occurrence of spontaneous pregnancy showed no statistically significant difference between GnRH cotreatment and the control groups.
  
  
  CONCLUSIONS
  Evidence from RCTs suggests a potential benefit of GnRH cotreatment with chemotherapy in premenopausal women, with higher rates of spontaneous resumption of menses and ovulation but not improvement in pregnancy rates. Data relating to study quality and possible bias for the majority of the outcomes in this review were not available, denoting possible selective reporting of trial data.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bedaiwy
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Setta
authors.forename: Nina
authors.initials: N
authors.lastname: Desai
authors.forename: William
authors.initials: W
authors.lastname: Hurd
authors.forename: David
authors.initials: D
authors.lastname: Starks
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Hesham G
authors.initials: HG
authors.lastname: Al-Inany
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents; D007987:Gonadotropin-Releasing Hormone