Fertility after treatment for Hodgkin's disease

Abstract

If these preliminary data are consisent in a larger group of patients, GnRH-a co-treatment should be considered in every woman of reproductive age receiving chemotherapy, in addition to assisted reproductive technologies and the investigation into ovarian cryopreservation for future in vitro maturation, autotransplantation or xenotransplantation.

How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries

“…There are several possibilities to preserve future fertility in women exposed to chemotherapy: in vitro fertilization (IVF) and embryo cryopreservation, ovarian tissue cryopreservation, unfertilized ova cryopreservation, and the administration of a gonadotropin-releasing hormone (GnRH) agonist [1][2][3][4][5][6][7]; see Table 1. The possibility of administering an adjuvant treatment that may minimize the gonadal damage caused by an otherwise successful treatment program is obviously very attractive [1][2][3][4][5][6][7].…”

“…The possibility of administering an adjuvant treatment that may minimize the gonadal damage caused by an otherwise successful treatment program is obviously very attractive [1][2][3][4][5][6][7]. Glode et al [8] tested this hypothesis using a murine model and concluded that an agonistic analogue of GnRH appeared to protect male mice from the gonadal damage normally produced by cyclophosphamide [1].…”

“…Although previous suggestions have been made [1,9] claiming that primordial germ cells fare better than germ cells that are part of an active cell cycle, this hypothesis has not been seriously tested clinically, until recently [1, 4, 7, 10 -12]. Whereas several investigators have demonstrated that GnRH agonists inhibit chemotherapyinduced ovarian follicular depletion in the rat [8], uncertainty remains regarding human application [1,4,[5][6][7][8][9][10][11][12]. The human ovary has lower concentrations of ovarian GnRH receptors and may not necessarily exhibit the same response as the rat ovary [1,4,[5][6][7][8][9][10][11][12].…”

“…Whereas several investigators have demonstrated that GnRH agonists inhibit chemotherapyinduced ovarian follicular depletion in the rat [8], uncertainty remains regarding human application [1,4,[5][6][7][8][9][10][11][12]. The human ovary has lower concentrations of ovarian GnRH receptors and may not necessarily exhibit the same response as the rat ovary [1,4,[5][6][7][8][9][10][11][12]. Ataya et al [12], in the only prospective, randomized study performed up to now in primates where follicles were histologically counted [12], found that GnRH agonists protected the ovary against cyclophosphamide-induced damage in rhesus monkeys by significantly decreasing the number of follicles lost during the chemotherapeutic insult, and by decreasing the daily rate of follicular decline.…”

Lack of evidence of disease contamination in ovarian tissue harvested for cryopreservation from patients with Hodgkin lymphoma and analysis of factors predictive of oocyte yield

“…Furthermore, the quality of tissue harvested does not appear to be adversely affected by patient's age or prior ABVD chemotherapy. As Hodgkin lymphoma (HL) is a common malignancy in young people (Blumenfeld et al, 2002), fertility preservation is an important issue to address when counselling patients prior to chemotherapy. With current regimens of chemotherapy and radiotherapy a large proportion of patients will be cured of their illness, but with the risk of long-term toxicity, particularly with recently developed intensive chemotherapy programmes such as escalated-dose BEACOPP (Bleomycin, Etoposide, Adriamycin s , Cyclophosphamide, Oncovin s , Procarbazine, Prednisolone) (Diehl et al, 2003).…”