title: Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy May Increase Pregnancy Rate in Survivors.
abstract: BACKGROUND
  The use of gonadotropin-releasing hormone analogs (GnRHas) for fertility preservation is not unequivocally accepted. It is controversial whether GnRHa can increase the pregnancy rate in survivors.
  
  
  METHODS
  This is a retrospective cohort study. Every patient referred for fertility preservation was offered cryopreservation of embryos, ova, and ovarian tissue and GnRHa. The patients were consecutively included. The primary outcome was spontaneous pregnancies. The secondary outcome was cyclic ovarian function (COF) versus premature ovarian failure (POF). These outcomes were assessed 2 years or more after chemotherapy.
  
  
  RESULTS
  We compared 286 patients who received gonadotropin-releasing hormone agonist (GnRHa) with chemotherapy with 188 patients who were treated with chemotherapy alone. Ovarian function could be determined in 217 patients. Overall, 87% (127 of 146) of the patients in the GnRHa group retained COF and 13% (19 of 146) suffered POF, whereas in the control group, 49% (35 of 71) experienced COF and 51% (36 of 71) suffered POF (p = .0001). The odds ratio (OR) for preserving COF was 6.87 for the patients who received GnRHa (95% confidence interval [CI] 3.4-13.4). Overall 60% (112 of 188) of the survivors conceived: 69.3% (84 of 122) of the patients in the GnRHa group compared with 42.4% (28 of 66) in the control group (p = .006). In the GnRHa group, 123 healthy newborns were delivered, versus 40 in the controls. Spontaneous pregnancies occurred in 65.6% (80 of 122) of the survivors in the GnRHa group versus 37.9% (25 of 66) in the control group (p = .0004, OR 3.12, 95% CI 1.7-5.8).
  
  
  CONCLUSIONS
  Adding GnRHa to chemotherapy significantly increases the OR for spontaneous conception, in addition to COF. It is suggested that GnRHa cotreatment should be added before and during gonadotoxic chemotherapy.
  
  
  CONCLUSIONS
  The use of gonadotropin-releasing hormone analogs (GnRHa) for fertility preservation is not unequivocally accepted and is even controversial. This study compared 286 patients who received GnRHa with chemotherapy with 188 patients who were treated with chemotherapy alone. Ovarian function could be determined in 217 patients. The odds ratio for preserving cyclic ovarian function was 6.87 for the patients who received GnRHa. Furthermore, the total and spontaneous pregnancy rate was significantly higher for those who received the agonist (p = .006). Adding GnRHa to chemotherapy significantly increased the odds ratio for spontaneous conception, in addition to preserving regular ovarian function. It is suggested that GnRHa cotreatment should be administered to young women in conjunction with gonadotoxic chemotherapy.
authors.affiliation: Department of Gynecology and Obstetrics, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel Department of Reproductive Endocrinology, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel bzeev@techunix.technion.ac.il z_blumenfeld@rambam.health.gov.il.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Blumenfeld
authors.affiliation: Department of Reproductive Endocrinology, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Hilli
authors.initials: H
authors.lastname: Zur
authors.affiliation: Department of Hematology, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Eldad J
authors.initials: EJ
authors.lastname: Dann
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D003131:Combined Modality Therapy; D005260:Female; D005298:Fertility / Q000187:drug effects*; D059247:Fertility Preservation; D005833:Genital Neoplasms, Female / Q000150:complications / Q000188:drug therapy*; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000819:agonists / Q000031:analogs & derivatives; D006801:Humans; D010053:Ovary / Q000187:drug effects / Q000254:growth & development; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000473:pathology; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000473:pathology; D017741:Survivors
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: Fertility preservation; Gonadotropin-releasing hormone agonist; Pregnancies after gonadotoxic chemotherapy; Premature ovarian failure