GnRH-agonists in fertility preservation

Purpose of review Description of the recent progress in fertility preservation despite gonadotoxic chemotherapy, using gonadotropin-releasing hormone (GnRH)-agonists (GnRH-a). Recent findings Most groups of investigators have found a beneficial effect of the administered GnRH-a on minimizing the chemotherapy-associated gonadotoxic effect, in both hematologic diseases, mainly Hodgkin lymphoma and in young breast cancer patients. The GnRH-a cotreatment may also prevent premature ovarian failure in patients with nonmalignant, autoimmune diseases, such as systemic lupus erythematosus, exposed to cyclophosphamide pulsatile therapy. Moreover, GnRH-a coadministration proved to prevent the menometrorrhagia of young women during chemotherapy-induced thrombocytopenia more effectively than gestagens. Summary GnRH-a cotreatment appears to minimize ovarian damage. If these preliminary results are consistent in a larger group of patients and proven in a prospective randomized study, the GnRH-a cotreatment should be considered as a clinical routine in every woman in the reproductive age exposed to gonadotoxic chemotherapy, in addition to assisted reproductive technology, and to the investigational attempts of ova, follicles, or ovarian cryopreservation for future in-vitro maturation of primordial follicles, and ovarian autotransplantation or xenotransplantation.