Protection Of Ovarian Function By GnRH Agonists During Chemotherapy:a Meta-analysis

Background:The survival rates of malignant diseases such as breast cancer, lymphoma, leukemia is increasing, because of the improvements in therapeutic techniques. But premature ovarian failure (POF) is an established long-term adverse effect of chemotherapy in young women. The POF can lead to infertility and amenorrhea and typical climacteric symptoms, which have a significant impact on quality of life in young women. Younger women of childbearing age are confronted with the risk of infertility by chemotherapy-induced amenorrhea. Though a number of options to preserve fertility are available, hormonal protection with GnRH analogs has an edge over the others since it is less invasive and more convenient.Animal studies and phase Ⅱ clinical research have suggested that GnRHa can lead to temporary ovarian suppression to preserve ovarian function. Recently several studies have been conducted on the ovarian function preservation in young women undergoing gonadotoxic chemotherapy. But the conclusions drawn from these studies are not unanimous.In this paper, we conducted a meta-analysis to assess the efficacy of GnRH agonists in protecting the ovaries against chemotherapy induced damage in premenopausal women with malignant diseases.Objective:This study was designed to assess the overall performance of GnRHa in preserving the ovarian function in young women undergoing chemotherapy.Methods:Electronic literature databases including Pubmed, MEDLINE, Cochrane library, Embase, CNKI, Wanfang databases were searched for articles published till December 2014. The articles written in both Chinese and English languages were considered. Only randomized controlled trials (RCT) were selected.Main Outcome Measure was evaluated by assessing the post-chemotherapy ovarian function. A random-effects model was used to calculate the risk ratio (RR) and associated 95% confidence intervals (95% CI).Results:Out of the eight RCTs including 621 patients,321 women were treated with GnRHa during chemotherapy,9.66% of whom suffered premature ovarian failure (POF). On the other hand 26.67% of the remaining 300 women suffered POF. More women treated without GnRHa experienced post-chemotherapy premature ovarian failure (POF), yielding a RR of 0.45 (chemotherapy plus GnRHa vs. chemotherapy alone,95% confidence interval (CI) [0.22,0.92].Conclusion:Based on the available studies, GnRHa plays an important role in the prevention of post-chemotherapy POF but not exhibit its protective effects in fertility. More randomized controlled trials are needed to reach more convinced conclusion.