Endocrine prevention of chemotherapy-induced ovarian failure

Abstract

More than 10 recent meta-analyses have concluded that GnRHa is beneficial and may decrease the risk of premature ovarian failure and increase the pregnancy rate in survivors. Furthermore, two recent international meetings of experts have concluded that GnRHa is effective and should be offered to every young woman facing gonadotoxic chemotherapy.

Fertility Preservation Using GnRH Agonists: Rationale, Possible Mechanisms, and Explanation of Controversy

“…Eighteen meta-analyses of RCTs 13 and 4 recent international expert consensus meetings, 28,29,54,58 in addition to many smaller studies, have critically summarized the utility of GnRHa adjuvant co-treatment along with chemotherapy, concluding that this co-treatment significantly reduces the risk of POF and increases the PR in survivors. 1,4-9,13-15,19-63 Three recent, large prospective RCTs in patients with breast cancer support the use of GnRHa cotreatment for fertility preservation. 34,35,46 The US, POEMS–SWOG/S0230 study enrolled only hormone receptors (HR)-negative breast cancer patients, 34 whereas most patients in the Italian PROMISE–GIM6 …”

“…1,4-9,13-15,19-37 Therefore, this noninvasive and inexpensive treatment has gained ubiquitous interest and popularity. 1,4-9,13-15,19…”

“…1,4-9,13-15,19-63 Although 9 studies including 572 patients reported that GnRHa treatment before and along with chemotherapy did not bring about a significant decrease in POF rate, over 24 studies (15 retrospective and 9 randomized controlled trial [RCT]) including over 3100 patients receiving this treatment for breast cancer, hematologic cancers, or autoimmune diseases necessitating chemotherapy reported a significant decrease in POF rate in survivors. 1,4-9,13-15,19…”

“…63 In addition, GnRHa can effectively prevent thrombocytopenia-associated menorrhagia in the treated patients. 1,5,9,13-15…”

Effect of melatonin on the peripheral T lymphocyte cell cycle and levels of reactive oxygen species in patients with premature ovarian failure

“…It is characterized by primary or secondary amenorrhea accompanied by increased blood gonadotropin levels and reduced levels of estrogen. The clinical features primarily include symptoms related to low estrogen such as depression, facial flushing, and low libido (1,2). Roussev et al examined 1,858 women with natural amenorrhea and demonstrated that the incidence of POF was <1% before the age of 40 years, and <1/1,000 in women aged under 30 years (3).…”