Use of GnRH analogs for functional protection of the ovary and preservation of fertility during cancer treatment in adolescents: A preliminary report

Objective. Recent success in polychemotherapy (PCT) in adolescent female ca ncer patients has become a source of concern for specialists who also striv e to preserve fertility. We studied whether gonadotropin-releasing hormone (GnRH) analogs could prevent the early onset of ovarian insufficiency postc hemotherapy and protect fertility. Methods. The patients were divided into three groups: Control group 1 (Grou p A), premenarchal patients aged 3 to 7.5 years (n 5), were not given GnRH analogs administered prior to PCT. Postmenarchal patients (Group B), aged 1 4.7 to 20 years (n = 12) with normal menstrual rhythm and ovulatory cycles, received treatment with GnRH analogs prior to PCT. Control group 2 (Group C), postmenarchal patients aged 15.9 to 20 years (n = 4), received PCT but no GnRH analog protection. All groups received the PCT regimens CAVPE, CVPP , ABVD, TAMO, ARA-C, and MTT. In group B, leuprolide acetate inhibition was obtained with a depot injection administered each month before and during treatment with PCT, To accelerate the timing of ovarian regression, a subcu taneous injection (0.2 mg) was administered simultaneously. Results. In Group A, patients had spontaneous menarche between the ages of 12 and 17.9 years, followed by normal menstruation and ovulatory cycles. Th ree patients became pregnant. After GnRH analog withdrawal, Group B patient s continued with normal ovulatory cycles. Two patients became pregnant. Gro up C patients presented hypergonadotrophic hypoestrogenic amenorrhea, Conclusion. GnRH analog treatment before and during PCT enhances ovarian fu nction and preserves adolescent fertility. The results must be confirmed in a larger study. (C) 2001 Academic Press.