Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis

Objective To determine whether gonadotropin-releasing hormone (GnRH) analog cotreatment with chemotherapy provides better reproductive outcomes for women at risk of premature ovarian failure (POF) as a side-effect of gonadotoxic chemotherapy. Design Systematic review and meta-analysis. Setting Unive...

Full description

Saved in:

Bibliographic Details
Published in:	Fertility and sterility 2011-03, Vol.95 (3), p.906-914.e4
Main Authors:	Bedaiwy, Mohamed A., M.D., Ph.D, Abou-Setta, Ahmed M., M.D., Ph.D, Desai, Nina, Ph.D., H.C.L.D, Hurd, William, M.D, Starks, David, M.D, El-Nashar, Sherif A., M.B.B.Ch., M.S, Al-Inany, Hesham G., M.D., Ph.D, Falcone, Tommaso, M.D
Format:	Article
Language:	eng
Subjects:	Antineoplastic Agents - adverse effects Biological and medical sciences Chemotherapy Diseases of mother, fetus and pregnancy Female gonadotrophin-releasing hormone Gonadotropin-Releasing Hormone - administration & dosage Gynecology. Andrology. Obstetrics Humans Incidence Infertility, Female - chemically induced Infertility, Female - epidemiology Infertility, Female - prevention & control Internal Medicine Medical sciences meta-analysis Neoplasms - drug therapy Neoplasms - epidemiology Obstetrics and Gynecology Pregnancy Pregnancy Rate Pregnancy. Fetus. Placenta premature ovarian failure Primary Ovarian Insufficiency - chemically induced Primary Ovarian Insufficiency - epidemiology Primary Ovarian Insufficiency - prevention & control randomized trial
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective To determine whether gonadotropin-releasing hormone (GnRH) analog cotreatment with chemotherapy provides better reproductive outcomes for women at risk of premature ovarian failure (POF) as a side-effect of gonadotoxic chemotherapy. Design Systematic review and meta-analysis. Setting University-affiliated research centers. Patient(s) None. Intervention(s) Electronic and manual searches (e.g., MEDLINE, EMBASE, CENTRAL) up to January 2010 were performed to identify randomized controlled trials (RCTs) comparing GnRH cotreatment with chemotherapy alone in premenopausal women. Main Outcome Measure(s) Incidence of POF after treatment, incidence of women with resumption of ovulation, POF after an initial normal cycle, normal cycles but abnormal markers of ovarian reserve, spontaneous occurrence of pregnancy after treatment, and time to reestablishment of menstruation; data also extracted to allow for an intention-to-treat analysis. Result(s) Twenty-eight RCTs were identified, but only six met the inclusion criteria. Data were only available for the incidence of women with new onset of POF, resumption of ovulation, and occurrence of pregnancy. The incidence of POF or resumption of ovulation both demonstrated a statistically significant difference in favor of the GnRH cotreatment. The occurrence of spontaneous pregnancy showed no statistically significant difference between GnRH cotreatment and the control groups. Conclusion(s) Evidence from RCTs suggests a potential benefit of GnRH cotreatment with chemotherapy in premenopausal women, with higher rates of spontaneous resumption of menses and ovulation but not improvement in pregnancy rates. Data relating to study quality and possible bias for the majority of the outcomes in this review were not available, denoting possible selective reporting of trial data.
ISSN:	0015-0282 1556-5653