title: Protecting Ovaries During Chemotherapy Through Gonad Suppression: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To estimate whether gonadotropin-releasing hormone (GnRH) analog administration during chemotherapy can protect against development of ovarian toxicity.
  
  
  METHODS
  MEDLINE (1966 to present), EMBASE (1980 to present), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched through March 2015 using the phrases: "gonadotropin-releasing hormone," "chemotherapy," and "premature ovarian failure." Hand-search on conference abstracts, SCOPUS, and ISI Web of Science were also searched.
  
  
  METHODS
  Published English-language randomized controlled trials comparing resumption of ovarian function between GnRH analogs plus chemotherapy with chemotherapy without GnRH analogs were included. Studies including women with pelvic metastases or recent history of receiving chemotherapy were excluded. Accordingly, 10 eligible trials (907 women) were analyzed.
  
  
  RESULTS
  Our primary outcome was the proportion of women with resumed ovarian function (defined as resumption of menstruation, prevention of chemotherapy-induced ovarian failure, or both) at the longest follow-up after the end of chemotherapy. Secondary outcomes were evaluating ovarian reserve parameters and pregnancy. Risk ratio was used to integrate qualitative results and mean difference was used for quantitative data. Gonadotropin-releasing hormone analog cotreatment did not significantly increase ovarian function resumption (320/468 [68.4%] in GnRH analog arm and 263/439 [59.9%] in the chemotherapy alone arm; risk ratio 1.12, 95% confidence interval [CI] 0.99-1.27). No protective effect existed after subgroup analyses (type of malignancy [P=.31], age [P=.14], and GnRH analog type [P=.44]). Gonadotropin-releasing hormone analogs did not protect any of ovarian reserve parameters, whether follicle-stimulating hormone (mean difference -2.63, 95% CI -7.33 to 2.07), antral follicle count (mean difference 1.66, 95% CI -0.69 to 4.01), or anti-Müllerian hormone (mean difference 0.31, 95% CI -0.41 to 1.03). Spontaneous pregnancy was also comparable (risk ratio 1.63, 95% CI 0.94-2.82).
  
  
  CONCLUSIONS
  Gonadotropin-releasing hormone analog administration during chemotherapy does not appear to protect the ovaries from gonadal toxicity. It is not a reliable method for fertility preservation.
authors.affiliation: Departments of Obstetrics and Gynecology, Zagazig University School of Medicine, Zagazig, and Cairo University Faculty of Medicine, El Manial, Cairo, Egypt; and the Department of Obstetrics and Gynecology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Eman
authors.initials: E
authors.lastname: Elgindy
authors.forename: Hoda
authors.initials: H
authors.lastname: Sibai
authors.forename: Amany
authors.initials: A
authors.lastname: Abdelghani
authors.forename: Magdy
authors.initials: M
authors.lastname: Mostafa
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D065851:Ovarian Reserve; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D020011:Protective Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D020011:Protective Agents; D007987:Gonadotropin-Releasing Hormone