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 »

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Unknown risk of the reintroduction of malignant cells in a Danish cohort of women autotransplanted with ovarian tissue.

31 03 2011

To the Editor:

Ovarian cryopreservation appears to hold much promise for fertility preservation of women undergoing gonadotoxic therapy. In the Netherlands, cryopreservation of ovarian tissue has been performed for a number of cancer patients. No autotransplantation of ovarian tissue has been performed thus far, due (amongst other reasons) to concerns about the risk of reintroducing the malignancy with the transplant.

The available literature on this subject is not unequivocal. For example, Shaw et al. (1) have shown in a mouse model that lymphoma can be transmitted to the recipient by both fresh and frozen ovarian tissue grafts. Kim et al. (2), on the other hand, reassuringly demonstrated that none of the mice that were xenografted with human ovarian tissue fragments derived from patients with (non)Hodgkin lymphoma developed disease. Read the rest of this entry »





Study Raises Further Questions on the Effectiveness of GnRH Analogs as a Method of Gonadal Protection in Cancer Patients

1 06 2009

To the Editor:

While we read the recent manuscript from Badawy et al. (1) with great interest, we have concerns about their interpretation that GnRH analogs (GnRHa) preserve fertility. Read the rest of this entry »