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

Publication date: Available online 13 November 2019Source: Best Practice & Research Clinical Obstetrics & GynaecologyAuthor(s): Ruba Kado, W. Joseph McCuneAbstractAdministration 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 (GNRH-a) has emerged as a potential means to preserve both fertility and ovarian function through suppression of ovarian activity during treatment with alkylators. We review trials of GNRH-a 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 GNRH agonists have yielded mixed results. Trials in lupus patients receiving lower doses of cyclophosphamide alone utilizing depot leuprolide acetate have tended to show favorable results.
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research