Ovarian protection with gonadotropin-releasing hormone agonists during cyclophosphamide therapy in systemic lupus erythematosus

Ruba Kado, W. Joseph McCune
Best practice & research. Clinical obstetrics & gynaecology · 2019 · vol. 64 , pp. 97–106 · doi:10.1016/j.bpobgyn.2019.10.008 · PMID:31866283 · W2986679565
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This review examines trials of gonadotropin-releasing hormone agonists for ovarian protection during cyclophosphamide therapy, finding mixed results in cancer patients but favorable outcomes in systemic lupus erythematosus patients receiving lower doses.

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Abstract

Administration of cyclophosphamide (CYC), an alkylating agent used to treat malignancies and severe rheumatic diseases, creates a risk of ovarian insufficiency that is related to the intensity and duration of therapy and the age of the patient. To preserve reproductive capacity in the appropriate clinical setting, oocyte, embryo, and/or ovarian tissue cryopreservation are recommended. Medical protection with depot gonadotropin-releasing hormone agonists (GNRHa) has emerged as a potential means to preserve both fertility and ovarian function through the suppression of ovarian activity during treatment with alkylators. We review the trials of GNRHa for ovarian protection in both cancer and rheumatic disease patients. Trials in cancer patients receiving CYC alone, or in combination with other gonadotoxic agents that have employed several different GNRHa have yielded mixed results. Trials in lupus patients receiving lower doses of CYC alone utilizing depot leuprolide acetate have tended to show favorable results.

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MeSH descriptors

Alkylating Agents Cyclophosphamide Gonadotropin-Releasing Hormone Immunosuppressive Agents Lupus Erythematosus, Systemic Primary Ovarian Insufficiency Alkylating Agents Alkylating Agents Alkylating Agents Cyclophosphamide Cyclophosphamide Cyclophosphamide Female Fertility Agents, Female Gonadotropin-Releasing Hormone Humans Immunosuppressive Agents Leuprolide Lupus Erythematosus, Systemic Lupus Erythematosus, Systemic

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