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abstract
The
prognosis of malignancies in young women undergoing chemotherapy has
dramatically improved recently, and more attention is given to the long
term quality of life, including fertility and reproductive function
preservation. Some chemotherapeutic drugs are known to be associated
with gonadal toxicity (cyclophosphamide, L-phenylanine mustard, busulfan
and nitrogen mustard) and others have less or un-quantified effects
(doxorubicin, bleomycin, vinca alkaloids, as vincristine and vinblastin,
cisplatin, nitrosoureas, cytosine arabinoside). Women are in need to
identify best options to minimize ovarian damage during chemotherapy
through the administration of protective drugs, better choice of therapy
and with advocating oncofertility preservation. We reviewed the
possible options focusing on the most studied gonadotrophin-releasing
hormone agonists (GnRH-a) and the psychologically promising oral
contraceptives (OC). Controversy exist on the benefit of gonadotrophin
releasing hormone agonist (GnRH-a) or combined oral contraceptive
administered at time of cancer therapy in preventing premature ovarian
failure in women and the available data from both human and animal
studies have been mixed. The best way to preserve fertility and ovarian
function in young women undergoing chemotherapy still remains to be
determined. In the absence of a best approach, each case should be
evaluated individually, considering patient's wishes and expectations,
the type of chemotherapy, age, obstetric history, ovarian reserve
(combining multiple indicators such as basal hormone profile, anti
müllerian hormone -AMH- and antral follicle count), family history of
premature ovarian failure. We present a review of the available evidence
on the value of administering GnRH-a and OC use to minimize or prevent
the effect of chemotherapy agents on reproductive function.
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