Protecting Fertility From Chemotherapy

One great advance in preventing loss of fertility and ovarian reserve from chemotherapy has been egg freezing.

But sometimes, for a variety of reasons, egg freezing may not be feasible for a particular individual. Prior to the advent of successful egg freezing I used to use a gonadotropin-releasing hormone (GnRHa) agonist to shut down the ovaries prior to chemotherapy, thereby protecting them somewhat from damage from the chemotherapy agents. Now a new study confirms the benefit from this approach.

Women treated with gonadotropin-releasing hormone agonists during treatment with chemotherapy for premenopausal early breast cancer experienced a significant reduction in the risk for chemotherapy-induced premature ovarian insufficiency, according to data from a systemic review and meta-analysis presented at the San Antonio Breast Cancer Symposium.

A greater proportion of women treated with gonadotropin-releasing hormone (GnRHa) had a posttreatment pregnancy. “This strategy should be considered as an option to reduce the likelihood of chemotherapy-induced premature ovarian insufficiency and potentially improve future fertility among premenopausal early breast cancer patients undergoing neoadjuvant chemotherapy,” Matteo Lambertini, MD, of the Institute Jules Bordet in Brussels, Belgium, said during a press briefing.

Chemotherapy-induced premature ovarian insufficiency and subsequent infertility are two concerns that affect young patients with breast cancer. Previous research has suggested that GnRHa may prevent the loss of ovarian function from cytotoxic agent exposure. However, the majority of clinical trials that have investigated this are limited by short-term follow-up and did not report on posttreatment pregnancies.

Lambertini and colleagues conducted a meta-analysis that included data on 722 premenopausal women (median age, 38 years) with early-stage breast cancer randomly assigned to chemotherapy alone (n = 359) or with concurrent GnRHa. The overall rate of premature ovarian insufficiency was 14.1% among women treated with concurrent GnRHa vs. 30.9% among those treated with chemotherapy alone. Thus, women treated with concurrent GnRHa had a 62% lower risk for premature ovarian insufficiency compared with women treated with chemotherapy alone.

But I still believe that egg freezing is the better option for preserving a woman’s fertility from chemotherapy if it is feasible time-wise and financially.

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