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

Blumenfeld, Zeev

doi:10.1634/theoncologist.12-9-1044

Cited by 250 publications

(199 citation statements)

References 86 publications

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“…The risk of ovarian damage is reduced, although not entirely eliminated, as there can be extension of the radiation beyond the pelvis [30]. The use of GnRH agonists to downregulate the HPG axis prior to and during chemotherapy remains controversial, as conflicting results regarding their true protective effects have been reported [31,32].…”

Section: Barriers To Treatment and Referralmentioning

confidence: 99%

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Köhler

Kondapalli

Shah

et al. 2010

J Assist Reprod Genet

172

135

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Purpose Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide. Materials and methods The SPARE survey consists of 22 questions assessing pediatric oncology specialists' attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed. Genet (2011) 28:269-277 DOI 10.1007 Capsule The SPARE survey captured marked disparities between pediatric oncologists' attitudes and practice patterns regarding fertility preservation for male and female pediatric oncology patients. Statement of Financial SupportResults The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients. Conclusion Our study demonstrates pediatric oncologists' motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.

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Section: Barriers To Treatment and Referralmentioning

confidence: 99%

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Köhler

Kondapalli

Shah

et al. 2010

J Assist Reprod Genet

172

135

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“…Additionally, blood flow to the ovary is increased, thereby theoretically delivering increased quantity of MTX to the ovary and causing direct damage to oocytes and granulosa cells [8]. While data exists on the maintenance of tubal patency, resumption of menses, and clinical pregnancy rates, few studies have evaluated the effects of MTX on ovarian reserve and the effectiveness of future assisted reproductive technology (ART) [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Methotrexate does not affect ovarian reserve or subsequent assisted reproductive technology outcomes

Boots¹,

Hill²,

Feinberg

et al. 2016

J Assist Reprod Genet

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Purpose The purpose of this research was to study whether methotrexate (MTX) as treatment for ectopic pregnancy (EP) impacts the future fertility of women undergoing assisted reproductive technology (ART) Methods In a systematic review and multi-center retrospective cohort from four academic and private fertility centers, 214 women underwent an ART cycle before and after receiving MTX as treatment for an EP. Measures of ovarian reserve and responsiveness and rates of clinical pregnancy (CP) and live birth (LB) were compared in the ART cycles prior and subsequent to MTX. Results Seven studies were identified in the systematic review, and primary data from four institutions was included in the final analysis. Women were significantly older in post-MTX cycles (35.3 vs 34.7 years). There were no differences in follicle stimulating hormone, antral follicle count, duration of stimulation, oocytes retrieved, or fertilization rate between pre-and post-MTX cycles. However, post-MTX cycles received a significantly higher total dose of gonadotropins (4206 vs 3961 IU). Overall, 42 % of women achieved a CP and 35 % achieved a LB in the post-MTX ART cycle, which is similar to national statistics. Although no factors were identified that were predictive of LB in young women, the number of oocytes retrieved in the previous ART cycle and current AFC were predictive of LB (AUC 0.76, 0.75) for the older women. Conclusions MTX does not influence ovarian reserve, response to gonadotropin stimulation, and CP or LB rate after ART. MTX remains a safe and effective treatment option for women with asymptomatic EPs.Capsule As treatment for an ectopic pregnancy, methotrexate does not affect ovarian reserve, response to gonadotropin stimulation, clinical pregnancy, or live birth rates in subsequent assisted reproductive tenchology cycles.

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“…Therefore, the late effects of cancer treatment have recently gained a worldwide interest [1][2][3][4], and the protection against iatrogenic infertility caused by chemotherapy assumes a high priority. Resumption of menses may not be an accurate marker of fertility, because infertility and diminished ovarian reserve are observed in women who resume normal menstrual cycles after treatment with chemotherapy [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Several options have been put forward for preserving female fertility: ovarian transposition, cryopreservation of embryos, unfertilized oocytes, and/or ovarian tissue, and administration of GnRHa in an attempt to decrease the gonadotoxic effects of chemotherapy by simulating a prepubertal hormonal milieu [1][2][3][4][5][6]. Unfortunately, none of the suggested methods is ideal, and none guarantees future fertility in survivors.…”

Section: Introductionmentioning

confidence: 99%

“…The in vitro maturation of primordial follicles to fertilizable metaphase-II oocytes is a future endeavor with enormous potential, but it requires overcoming many technological obstacles and is not clinically available yet. We have recently summarized the case for and against gonadotropinreleasing hormone agonist (GnRHa) for fertility preservation [1,3,4]. Indeed, GnRHa has been used by many groups of clinicians for minimizing the gonadotoxic effects of chemotherapy, with the rationale and philosophy that preventing premature ovarian failure (POF) in survivors is preferable to treating it, following the dictum: "an ounce of prevention is worth a pound of cure" [1].…”

Section: Introductionmentioning

confidence: 99%

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Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy May Increase Pregnancy Rate in Survivors

2015

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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. Patients and 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). Conclusion. 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. Implications for Practice: 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.

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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

Cited by 250 publications

References 86 publications

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

Methotrexate does not affect ovarian reserve or subsequent assisted reproductive technology outcomes

Gonadotropin-Releasing Hormone Agonist Cotreatment During Chemotherapy May Increase Pregnancy Rate in Survivors

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