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Are GnRH-agonists effective for fertility preservation in women undergoing treatment for cancer?
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The jury is still out.
The jury is still out; there are studies ongoing. In fact, I am leading a Southwest Oncology Group study that is addressing this issue. It’s an ongoing, large, randomized study in which half of the women will receive a GnRH analog during chemotherapy and half will receive chemotherapy in the usual manner. Participants are being followed for several years afterwards with assessment of both ovarian function outcomes and fertility outcomes. This study, hopefully, will give us a more definitive answer. It will likely be a few more years before it completes accrual; we have more than 180 patients enrolled in the study right now, but we’re requiring more than 400 patients total.
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There have been some published studies suggesting a benefit to this method, although it requires a randomized study and careful follow-up for the outcomes of interest to be able to say definitively whether the intervention is effective. If I had to predict the outcome, it is likely that we will find some benefit to GnRH analogs for reducing the rate of early ovarian failure; however, it’s not going to be a miracle treatment for everybody. Hopefully, we will be able to improve a woman’s chances for preserving fertility, but it is likely that additional interventions will still be required for many individuals.
Halle Moore, MD, is a Staff Physician in the Department of Solid Tumor Oncology, Tausig Cancer Center, Cleveland Clinic.
They are very effective.
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In my opinion, the answer is definitely yes. Until about six months ago most of the studies and publications were clinical, nonprospectively randomized. However, in the last year we’ve had two prospective randomized trials and a meta-analysis proving what we believed for the last 15 years— that it’s very effective. It decreases the risk of premature ovarian failure in young women exposed to gonadotoxic chemotherapy from about 40% to 50% to less than 10%.
Although we offer it to most or almost all of the young women exposed to gonadotoxic chemotherapy — because we cannot at this stage guarantee 100% success — we do not offer it instead of, but in addition to IVF and cryopreservation of embryos, ova, and/or ovarian tissue. For those young women without partners we offer it in addition to cryopreservation of nonfertilized ova and also cryopreservation of ovarian tissue. Of course, it will take probably five, maybe 10 years to definitely answer which of the three avenues of fertility preservation, or what combination of the three methods, is the best modality to preserve future fertility in these young women.
Zeev Blumenfeld, MD, is an Associate Professor of Obstetrics and Gynecology at the Technion Institute of Technology, Israel