title: [Protective effect of GnRH analogues on the reproductive capacity of women with neoplasia or autoimmune disease who require chemotherapy. Final results of a phase ii clinical trial].
abstract: OBJECTIVE
  In order to avoid the toxic effect of chemotherapy, it has been proposed to use GnRH agonist analogues (GnRHa) to inhibit the depletion of ovarian follicles. Nevertheless, there is controversy about its effectiveness. This clinical trial has been conducted with the aim to assess the protective effect of GnRH analogues on the reproductive capacity of women with malignancies or autoimmune diseases, which require chemotherapy.
  
  
  METHODS
  Open phase ii single-center clinical trial. During chemotherapy, a total of 5 doses of GnRH antagonist analogue at a dose interval of 3 days and/or a monthly dose of GnRHa were administered. Hormonal determinations prior to the start of the CT treatment were conducted during treatment and at the end of it.
  
  
  RESULTS
  The inclusion of patients was prematurely concluded when incorporating the determination of anti-Müllerian hormone (AMH) as a parameter for assessing the ovarian reserve. Out of 38 patients, 23 (60.5%, 95%CI 43.4-76.0) had AMH values below normal following completion of treatment. An intermediate analysis was carried out observing that while most patients were recovering the menstrual cycle (86.6% 95%CI 71.9-95.6), they had reduced levels of AMH.
  
  
  CONCLUSIONS
  Although most patients recovered their menstrual cycles, the ovarian reserve, assessed by the concentration of AMH, decreased in many patients. Therefore, we can conclude that the concomitant treatment of chemotherapy and GnRH analogues does not preserve the loss of follicular ovarian reserve.
authors.affiliation: Unidad de Reproducción Asistida, Servicio de Ginecología y Obstetricia, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: jmgris@vhebron.net.
authors.forename: José M
authors.initials: JM
authors.lastname: Gris-Martínez
authors.affiliation: Hospital Universitario del Mar, Barcelona, España.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Trillo-Urrutia
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital Universitario Vall d'Hebron, Barcelona, España.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gómez-Cabeza
authors.affiliation: Unidad de Densitometría Ósea, Servicio de Medicina Nuclear, Hospital Universitario Vall d'Hebron, Barcelona, España.
authors.forename: Gloria
authors.initials: G
authors.lastname: Encabo-Duró
mesh_terms: D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000188:drug therapy*; D015415:Biomarkers; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology / Q000627:therapeutic use*; D059247:Fertility Preservation / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007247:Infertility, Female / Q000517:prevention & control*; D008598:Menstruation; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010053:Ovary / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D017329:Triptorelin Pamoate / Q000494:pharmacology / Q000627:therapeutic use*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D005300:Fertility Agents, Female; D007166:Immunosuppressive Agents; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix
keywords: Análogos de la hormona liberadora de gonadotropina; Autoimmune diseases; Enfermedades sistémicas; Fertility preservation; Gonadotropin releasing hormone analogues; Neoplasia; Neoplasias; Preservación de la fertilidad