Gonadotropin releasing hormone agonist (GnRHa) therapy is the most studied fertoprotective agent, but with conflicting results [5-7]. Reasons include endpoints that do not predict long-term ovarian function such as resumption of menstruation, follicle stimulating hormone (FSH) and estradiol levels, and a lack of data on pregnancy outcomes.   Additionally, many studies used different GnRHa therapies, had short follow-up periods and few were randomized [8, 9]. A recent prospective study with 257 patients used similar endpoints but reported improved pregnancy outcomes with Goserelin in hormone receptor negative breast cancer patients receiving adjuvant therapy [10]. Ultimately, meta-analysis of GnRHa therapy has shown ovarian protection in breast cancer patients, but widespread use of GnRHa therapy as an ovarian protective agent in all malignancies cannot be recommended at this time [6]. For this reason, additional agents have been evaluated for efficacy.

 

References