Preserving ovarian function during chemotherapy

Cancer. The disease itself is the cause of so much hardship and suffering. What is worse is that there are direct and indirect effects of cancer - the untold burden on friends, family and loved ones. For young women with breast cancer, there are more deep-seated and particular challenges when considering future fertility.

A recent paper published in the Journal of Clinical Oncology set out to evaluate the use of a particular treatment for amenorrhea (absense of menses) in women that are undergoing chemotherapy for early-stage breast cancer. Particularly in younger women of child-bearing age there is the risk of compromising fertility with the onset of temporary or permanent cessation of menses as a direct result of chemotherapy.

To overcome this, and to possibly preserve ovarian function by preventing ovarian failure, temporary ovarian suppression with analogs of gonadotropin-releasing hormone (GnRH) are used during chemotherapy. Triptorelin is one such analog of GnRH used to preserve ovarian function.

The conclusion of the randomised trial revealed that “amenorrhea rates on triptorelin were comparable to those seen in the control group” write the authors, “when stratified for age, estrogen receptor status, and treatment regimen”.

Breast cancer effects more and more women, and fortunately, more and more women survive it. However, avoiding the long-term effects of treatment is now the priority. In this case, the effects of cancer treatment last long after the individual has survived cancer. Chemotherapy-induced amenorrhea is a serious concern for women undergoing cancer therapy. Importantly, for women who are interested having children in the future, breast cancer chemotherapy can diminish a woman’s fertility even if she does not experience immediate menopause.

The trial - with premenopausal aged women randomly assigned to receive triptorelin or no triptolerin during breast cancer chemotherapy - eventually showed that menstruation resumed in 19 of 21 patients in the control group and in 23 of 26 in the triptorelin group. Their results were in stark contrast to previously reported findings that cited considerable reductions in amenorrhea rates with other GnRH analogs.

In conclusion, researchers suggested that GnRH agonists should not be recommended in treatment, since they discovered no statistical difference between their trial groups. And other ways of preserving ovarian function should be evaluated. Of course, more drastic and pronounced fertility preservation techniques exists and could be employed before chemotherapy starts. Such as in vitro fertilization with embryo cryopreservation or oocyte or ovarian cryopreservation. This would also go some way to avoid more complications with fertility further down the line. The greatest concern is whether preservation of ovarian function and a subsequent pregnancy in a breast cancer survivor could increase the risk of recurrence. It can also be difficult to determine if a breast cancer survivor is fertile, as a woman who is menstruating may be infertile, and women who are amenorrheic may remain fertile.

This study represents one of many that are actively assessing the question of return of menses after treatment during chemotherapy.


Written by Dr. Charles Ebikeme for The All Results Journals.