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

Blumenfeld, Zeev

doi:10.1177/1179558119870163

Cited by 50 publications

(48 citation statements)

References 142 publications

(826 reference statements)

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“… 65 - 71 One of the main reasons for this controversy is represented by the lack of proper data demonstrating the mechanism behind the protective effect of this strategy. 72 - 75 Nevertheless, clinical data for patients with breast cancer have recently solved the controversy and this option is now considered a standard strategy for ovarian function preservation in this setting. 16 , 18 , 76 - 78 However, this is not an alternative to cryopreservation options as a strategy for fertility preservation considering the more limited evidence regarding the number of pregnancies obtained by patients who received this strategy.…”

Section: Burning Questions During the Oncofertility Counseling Of Youmentioning

confidence: 99%

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

Arecco

Perachino

Damassi

et al. 2020

Breast Cancer�(Auckl)

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The improved prognosis of breast cancer patients makes survivorship issues an area of crucial importance. In this regard, an increased attention is needed toward the development of potential anticancer treatment-related long-term side-effects, including gonadal failure and infertility in young women. Therefore, fertility preservation and family planning are crucial issues to be addressed in all young women of reproductive age with newly diagnosed cancer. Despite a growing availability of data on the efficacy and safety of fertility preservation options and the fact that conceiving after prior history of breast cancer has become more accepted over time, there are still several gray zones in this field so that many physicians remain uncomfortable to deal with these topics. The purpose of this review is to answer some of the most controversial questions frequently asked by patients during their oncofertility counseling, in order to provide a detailed and up-to-date overview on the evidence available in this field to physicians involved in the care of young women with breast cancer.

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Section: Burning Questions During the Oncofertility Counseling Of Youmentioning

confidence: 99%

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

Arecco

Perachino

Damassi

et al. 2020

Breast Cancer�(Auckl)

View full text Add to dashboard Cite

show abstract

“…Notably, the biological rationale behind its protective effect remains to be defined. [98][99][100][101] Nevertheless, after many years of debate on the efficacy and safety of this approach, [102][103][104][105][106] recent clinical data have led current guidelines to recommend its use as a strategy to preserve ovarian function during chemotherapy, mainly in the case of young women with breast cancer. 13 14 107-110 Most of the evidence available on the efficacy and safety of this strategy exists for premenopausal patients with breast cancer.…”

Section: Lhrha During Chemotherapymentioning

confidence: 99%

Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

et al. 2020

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Survivorship is an area of paramount importance to be addressed as early as possible after cancer diagnosis by all health care providers. On this regard, cancer care in young patients often poses several age-related considerations among which fertility and pregnancy-related issues have a crucial role. According to the available guidelines on the topic, all patients with cancer diagnosed during their reproductive years should be provided a proper oncofertility counselling before starting anticancer treatments. This is an important step in order to inform patients about the potential treatment-induced gonadotoxicity and the available strategies for fertility preservation so that they can be referred as early as possible to fertility specialists if potentially interested in these options.In this manuscript, we aim to provide an up to date overview on the available efficacy and safety data with the main strategies for fertility preservation in male and female cancer patients in order to help optimising the oncofertility counselling performed by healthcare providers involved in cancer care and dealing with young patients. In male patients with cancer, sperm cryopreservation is the standard technique for fertility preservation. Oocyte/embryo cryopreservation, ovarian tissue cryopreservation and temporary ovarian suppression with luteinising hormone-releasing hormone agonists during chemotherapy are the main options in female patients with cancer.A multidisciplinary management building a strong network between fertility and oncology/haematology units is crucial to properly address fertility care in all young patients with cancer, at both diagnosis and during oncologic follow-up. Discussing fertility and pregnancy-related issues with young patients with cancer has to be considered mandatory nowadays keeping in mind that returning to a normal life (including the possibility to have a family and to live with as few side effects as possible) should be considered an important ambition in cancer care in the 21st century .

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“…161 Large, prospective, randomized controlled trials are still needed to determine the protective effect of GnRHas in hematologic malignancies and HCT and utilization of GnRHas for fertility preservation should be reserved for investigational use only. 162 Vaginal changes in HCT survivors are most often a result of cGVHD; patients may complain of non-specific symptoms, such as vaginal pain, burning, dysuria, a feeling of redness and swelling, perineal and perianal soreness, dryness, and dyspareunia. Of note, patients who are sexually active may feel these symptoms earlier in their post-HCT course.…”

Section: Female Survivorsmentioning

confidence: 99%

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

et al. 2020

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Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre‐, peri‐, and post‐HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15‐year cumulative incidence of severe or life‐threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long‐term complications, this delicate patient population requires life‐long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late‐occurring or long‐term complications in HCT survivors.

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

Cited by 50 publications

References 142 publications

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

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