Open Access

REVIEW

Pharmacological methods for ovarian function and fertility preservation in women with cancer: A literature review

by ANA S. CVETANOVIC^1,2,*, MATTEO LAMBERTINI^3,4, KEVIN PUNIE⁵, GORANA G. MATOVINA BRKO⁶, NIKOLA D. ZIVKOVIC^7,8, MAJA J. POPOVIC^6,9, MARIJANA M. MILOVIC KOVACEVIC¹⁰, LAZAR S. POPOVIC^6,9

1 Department for Oncology, Medical Faculty Nis, University of Nis, Nis, 18000, Serbia
2 Clinic of Oncology, University Clinical Centre Nis, Nis, 18000, Serbia
3 Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, 16100, Italy
4 Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, 16100, Italy
5 Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, 3001, Belgium
6 Department of Medical Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, 21208, Serbia
7 Department for Pathology, Medical Faculty Nis, University of Nis, Nis, 18000, Serbia
8 Center for Pathology, University Clinical Centre Nis, Nis, 18000, Serbia
9 Faculty of Medicine, University of Novi Sad, Novi Sad, 21000, Serbia
10 Department of Medical Oncology, Institute of Oncology and Radiology Serbia, Belgrade, 11000, Serbia

* Corresponding Author: ANA S. CVETANOVIC. Email:

Oncology Research 2024, 32(8), 1309-1322. https://doi.org/10.32604/or.2024.049743

Received 17 January 2024; Accepted 06 May 2024; Issue published 17 July 2024

Abstract

Oncofertility is an extremely significant topic that is increasingly being discussed owing to increased evidence indicating that fertility preservation does not affect the treatment outcomes of patients with cancer but significantly contributes to preserving life quality. The effect of chemotherapy can range from minimal effects to complete ovarian atrophy. Limited data are available on the effects of monoclonal antibodies and targeted therapies on the ovaries and fertility. Temporary ovarian suppression by administering a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy decreases the gonadotoxic effect of chemotherapy, thereby diminishing the chance of developing premature ovarian insufficiency (POI). At present, the concomitant administration of GnRH analogs during chemotherapy is the only accepted pharmacological method for preserving ovarian function. Notably, most randomized studies on the effectiveness of luteinizing hormone-releasing hormone agonists during chemotherapy in preventing POI have been conducted in women with breast cancer, with a considerably small number of studies on patients with hematological malignancies. Furthermore, most randomized controlled trials on breast cancer have revealed a decrease in treatment-induced POI risk, regardless of the hormone receptor status. In addition, studies on hematological malignancies have yielded negative results; nevertheless, the findings must be interpreted with caution owing to numerous limitations. Current guidelines from the American Society of Clinical Oncology and ESMO Clinical Practice Guidelines recommend sperm, oocyte, and embryo cryopreservation as a standard practice and only offering GnRHa to patients when proven fertility preservation methods are not feasible. In this manuscript, we present a comprehensive literature overview on the application of ovarian suppression with GnRHa during chemotherapy in patients with cancer by addressing preclinical and clinical data, as well as future perspectives in this field that upcoming research should focus on.

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