566 Obstetrics and Gynecology Board Review •••
❍ Can GnRH analogues be utilized for fertility preservation in women undergoing chemotherapy?
Yes. However, this is one of the most debated topics in fertility preservation discussions. Protective effect was seen
in early animal studies and mostly nonrandomized evidence. Many others studies, including the German Hodgkin
Study Group randomized trial, do not show an effect or others indicate mixed results. A summary in peer-reviewed
papers of patients receiving GnRH analogues versus controls revealed a rate of premature ovarian failure of 11.1%
in the GnRH group and 55.5% in the control group; however, only one of these was a randomized trial.
❍ Has triptorelin been shown to decrease the incidence of chemotherapy-induced early menopause in women
with breast cancer?
Yes. The absolute reduction was 17% in one recent open-label, randomized superiority study.
❍ What is the theoretical biologic problem with giving GnRH analogues as fertility preservation in women
being treated for breast, ovarian, or endometrial cancer?
Some suggest that since breast, ovary, and endometrium express GnRH receptors that it cannot be determined at
this point that GnRH analogues do not reduce the efficacy of chemotherapy either by effect on GnRH receptors or
by inducing glutathione S-transferases.
❍ Can GnRH analogues be utilized for fertility preservation in women undergoing radiation therapy?
No.