Evaluating treatment options to preserve fertility in young breast cancer patients treated with chemotherapy

This study evaluated whether taking a hormone called gonadotropin releasing hormone analog (GnRHa) during chemotherapy helps breast cancer patients preserve their fertility and prevent premature ovarian failure (POF).

In breast cancer, cells are dividing more rapidly than normal cells. Chemotherapy or medicines that kill cancer cells often target other rapidly dividing cells in the body. The ovaries (female reproductive organs where egg cells are made) normally have rapidly dividing cells, which means the chemotherapy drugs can also target the ovaries. When this happens in young, premenopausal (before menopause) women, they can lose normal function of the ovaries. This means that their ovaries will stop producing mature eggs and the hormone estrogen. This is called premature ovarian failure (POF). A common result of POF is infertility (inability to conceive). One current method of avoiding POF is to get the ovaries to stop making mature egg (a process called ovulation) cells during chemotherapy. GnRHa is a type of therapy used to stop the ovaries to produce estrogen, which will in turn stop ovulation. This process is thought to make the ovaries less targeted by the chemotherapy. When the GnRHa therapy is stopped, patients who still have functioning ovaries should start having periods again on their own. This is called spontaneous resumption of menses.  

This study combined the results of 7 different previous studies from 2000-2012 which included a total of 677 premenopausal women diagnosed with breast cancer. All patients were treated with chemotherapy for breast cancer. The study compared results for patients who received GnRHa together with chemotherapy and for those who did not. Results show that patients who received GnRHa therapy together with chemotherapy had a 2.83 times higher chance of resuming their menses compared to patients who did not receive GnRHa therapy.

In conclusion, this study showed that young women with breast cancer who received GnRHa therapy together with chemotherapy had an increased chance to have spontaneous menses compared to patients who did not receive GnRHa therapy. These results show a potential benefit of GnRHa therapy in preserving fertility in premenopausal breast cancer patients treated with chemotherapy.

Most studies included were small and large study data is lacking in this area. There was no information on GnRHa side effects, or egg reserve (number of good eggs left after chemotherapy).

Ask your doctor whether GnRHa therapy is a good option for your situation.