Comment on GnRH analogue cotreatment with chemotherapy for preservation of ovarian function

19 07 2011

To the Editor:

With great interest we have read the systematic review and meta-analysis by Bedaiwy et al. (1). The outcomes of the meta-analysis suggest a potential benefit of GnRH analogs as a cotreatment with chemotherapy in preserving future fertility, with higher rates of spontaneous resumption of menstruation and ovulation.

Six randomized controlled trials (RCTs) met the inclusion criteria. One of the largest studies was published in 2009 (2). After publication, this study was criticized for significant methodological weaknesses invalidating any conclusion based on this study (3). Additional criticisms were that the study group consisted of very young women compared to European and American women with breast cancer, had an unlikely low resumption of menstruation (in particular, only 33% of the controls), and had a short follow-up time (maximum 8 months after the last dose of chemotherapy) (4). Based on these criticisms we doubt the wisdom of including this controversial study. Read the rest of this entry »

Letter regarding “Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis”

12 07 2011

To the Editor:

We read with great interest the article of Escobar-Morreale et al., in which the authors report that women with polycystic ovary syndrome (PCOS) exhibit an elevation in circulating C-reactive protein (CRP) that was independent of obesity. We agree with their conclusion that this finding confirms the existing molecular evidence of a chronic low-grade inflammation possibly being involved in the pathogenesis of PCOS (1).

A possible autoimmune etiology of at least some cases of PCOS was mentioned in the early 1990s (2). Gleicher et al. have hypothesized that functional autoantibodies could contribute to its development, which represents hyperfunction of follicular recruitment in the ovaries (3). Moreover, the incidence of autoimmune thyroid diseases such as Hashimoto’s thyroiditis has been reported to be three-fold higher in women with PCOS than in the general female population (4). Read the rest of this entry »