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Chapter 15 - Use of GnRH Analogs for Prevention of Chemotherapy-Induced Gonadotoxicity

from Section 5 - Fertility Preservation Strategies in the Female: Medical/Surgical

Published online by Cambridge University Press:  27 March 2021

By
Matteo Lambertini ,
Florence Horicks  and
Isabelle Demeestere
Edited by
Jacques Donnez  and
S. Samuel Kim
Jacques Donnez
Affiliation:
Catholic University of Louvain, Brussels
S. Samuel Kim
Affiliation:
University of Kansas School of Medicine
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Summary

Although cancer remains a public health problem worldwide, survival has significantly improved over the past years thanks to major advances in both early detection and use of more effective anticancer treatments [1]. Progress has been especially rapid for hematological malignancies but has also concerned the majority of solid tumors [1]. Therefore, nowadays, addresing survivorship issues as early as possible is of crucial importance to avoid the potential serious long-term consequences of anticancer treatments [2]. On this regard, chemotherapy-induced gonadotoxicity is of particular concern for newly diagnosed premenopausal patients being associated with negative side effects including menopause-related symptoms and other negative sequelae such as the possible risk of infertility [3]. Therefore, at the time of diagnosis, all premenopausal women should be informed about the potential gonadotoxicity of chemotherapy as well as on the strategies available to counteract the risk of developing this side effect and its negative consequences [4–8].

Type
Chapter
Information
Fertility Preservation
Principles and Practice
 , pp. 171 - 181
Publisher: Cambridge University Press
Print publication year: 2021

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References

Siegel, RL, Miller, KD, Jemal, A. Cancer statistics, 2018. CA Cancer J Clin, 2018;68(1):7–30.Google Scholar
Miller, KD, Siegel, RL, Lin, CC et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin, 2016;66(4):271–289.CrossRefGoogle Scholar
Lambertini, M, Del Mastro, L, Pescio, MC et al. Cancer and fertility preservation: international recommendations from an expert meeting. BMC Med, 2016;14:1.Google Scholar
ISFP Practice Committee, Kim, SS, Donnez, J et al. Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancer. J Assist Reprod Genet, 2012;29(6):465–468.CrossRefGoogle ScholarPubMed
Peccatori, FA, Azim, HA Jr., Orecchia, R et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013;24 Suppl 6:vi160–170.CrossRefGoogle ScholarPubMed
Paluch-Shimon, S, Pagani, O, Partridge, AH et al. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast, 2017;35:203–217.CrossRefGoogle ScholarPubMed
Martinez, F. International Society for Fertility Preservation–ESHRE–ASRM Expert Working Group. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Fertil Steril, 2017;108(3):407–415.e11.Google Scholar
Oktay, K, Harvey, BE, Partridge, AH et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol, 2018;36(19):1994–2001.Google Scholar
De Vos, M, Smitz, J, Woodruff, TK. Fertility preservation in women with cancer. Lancet, 2014;384(9950):1302–1310.CrossRefGoogle ScholarPubMed
Turner, NH, Partridge, A, Sanna, G, Di Leo, A, Biganzoli, L. Utility of gonadotropin-releasing hormone agonists for fertility preservation in young breast cancer patients: the benefit remains uncertain. Ann Oncol, 2013;24(9):2224–2235.CrossRefGoogle Scholar
Blumenfeld, Z, Katz, G, Evron, A. “An ounce of prevention is worth a pound of cure”: the case for and against GnRH-agonist for fertility preservation. Ann Oncol, 2014;25(9):1719–1728.Google Scholar
Rodriguez-Wallberg, K, Turan, V, Munster, P, Oktay, K. Can ovarian suppression with gonadotropin-releasing hormone analogs (GnRHa) preserve fertility in cancer patients? Ann Oncol, 2016;27(2):257.CrossRefGoogle ScholarPubMed
Del Mastro, L, Lambertini, M. Gonadotropin-releasing hormone analogs for ovarian function protection during chemotherapy in young early breast cancer patients: the last piece of the puzzle? Ann Oncol, 2017;28(8):1683–1685.Google Scholar
Lambertini, M, Cinquini, M, Moschetti, I et al. Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. Eur J Cancer, 2017;71:25–33.CrossRefGoogle ScholarPubMed
Chapman, RM, Sutcliffe, SB. Protection of ovarian function by oral contraceptives in women receiving chemotherapy for Hodgkin’s disease. Blood, 1981;58(4):849–851.Google Scholar
Kishk, EAF, Mohammed Ali, MH. Effect of a gonadotropin-releasing hormone analogue on cyclophosphamide-induced ovarian toxicity in adult mice. Arch Gynecol Obstet, 2013;287(5):1023–1029.CrossRefGoogle ScholarPubMed
Tan, S-J, Yeh, Y-C, Shang, W-J et al. Protective effect of a gonadotropin-releasing hormone analogue on chemotherapeutic agent-induced ovarian gonadotoxicity: a mouse model. Eur J Obstet Gynecol Reprod Biol, 2010;149(2):182–185.Google Scholar
Demeestere, I, Streiff, AK, Suzuki, J et al. Follicle-stimulating hormone accelerates mouse oocyte development in vivo. Biol Reprod, 2012;87(1):3,1–11.Google Scholar
Rossi, V, Lispi, M, Longobardi, S et al. LH prevents cisplatin-induced apoptosis in oocytes and preserves female fertility in mouse. Cell Death Differ, 2017;24(1):72–82.Google Scholar
Blumenfeld, Z. How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries. The Oncologist, 2007;12(9):1044–1054.Google Scholar
Durlinger, AL, Kramer, P, Karels, B et al. Control of primordial follicle recruitment by anti-Müllerian hormone in the mouse ovary. Endocrinology, 1999;140(12):5789–5796.Google Scholar
Sánchez, F, Smitz, J. Molecular control of oogenesis. Biochim Biophys Acta, 2012;1822(12):1896–1912.Google Scholar
Roness, H, Gavish, Z, Cohen, Y, Meirow, D. Ovarian follicle burnout: a universal phenomenon? Cell Cycle, 2013;12(20):3245–3246.Google Scholar
Hasky, N, Uri-Belapolsky, S, Goldberg, K et al. Gonadotrophin-releasing hormone agonists for fertility preservation: unraveling the enigma? Hum Reprod, 2015;30(5):1089–1101.Google Scholar
Kitajima, Y, Endo, T, Nagasawa, K et al. Hyperstimulation and a gonadotropin-releasing hormone agonist modulate ovarian vascular permeability by altering expression of the tight junction protein claudin-5. Endocrinology, 2006;147(2):694–699.Google Scholar
Jayaprakasan, K, Campbell, BK, Hopkisson, JF et al. Effect of pituitary desensitization on the early growing follicular cohort estimated using anti-Mullerian hormone. Hum Reprod, 2008;23(11):2577–2583.Google Scholar
Dada, T, Salha, O, Allgar, V, Sharma, V. Utero-ovarian blood flow characteristics of pituitary desensitization. Hum Reprod, 2001;16(8):1663–1670.Google Scholar
Yu Ng, EH, Chi Wai, Chan C, Tang, OS, Shu Biu, Yeung W, Chung, Ho P. Effect of pituitary downregulation on antral follicle count, ovarian volume and stromal blood flow measured by three-dimensional ultrasound with power Doppler prior to ovarian stimulation. Hum Reprod, 2004;19(12):2811–2815.Google Scholar
Ben-Aharon, I, Granot, T, Meizner, I et al. Long-term follow-up of chemotherapy-induced ovarian failure in young breast cancer patients: the role of vascular toxicity. The Oncologist, 2015;20(9):985–991.CrossRefGoogle Scholar
Meirow, D, Dor, J, Kaufman, B et al. Cortical fibrosis and blood-vessels damage in human ovaries exposed to chemotherapy. Potential mechanisms of ovarian injury. Hum Reprod Oxf Engl, 2007 June;22(6):1626–1633.Google Scholar
Codacci-Pisanelli, G, Del Pup, L, Del Grande, M, Peccatori, FA. Mechanisms of chemotherapy-induced ovarian damage in breast cancer patients. Crit Rev Oncol Hematol, 2017;113:90–96.Google Scholar
Asimakopoulos, B, Nikolettos, N, Nehls, B et al. Gonadotropin-releasing hormone antagonists do not influence the secretion of steroid hormones but affect the secretion of vascular endothelial growth factor from human granulosa luteinized cell cultures. Fertil Steril, 2006;86(3):636–641.CrossRefGoogle Scholar
Harrison, GS, Wierman, ME, Nett, TM, Glode, LM. Gonadotropin-releasing hormone and its receptor in normal and malignant cells. Endocr Relat Cancer, 2004;11(4):725–748.Google Scholar
Whitelaw, PF, Eidne, KA, Sellar, R, Smyth, CD, Hillier, SG. Gonadotropin-releasing hormone receptor messenger ribonucleic acid expression in rat ovary. Endocrinology, 1995;136(1):172–179.Google Scholar
Gründker, C, Emons, G. Role of gonadotropin-releasing hormone (GnRH) in ovarian cancer. Reprod Biol Endocrinol, 2003;1:65.CrossRefGoogle ScholarPubMed
Blumenfeld, Z, von Wolff, M. GnRH-analogues and oral contraceptives for fertility preservation in women during chemotherapy. Hum Reprod Update, 2008;14(6):543–552.Google Scholar
Sobinoff, AP, Nixon, B, Roman, SD, McLaughlin, EA. Staying alive: PI3 K pathway promotes primordial follicle activation and survival in response to 3MC-induced ovotoxicity. Toxicol Sci, 2012;128(1):258–271.Google Scholar
Kalich-Philosoph, L, Roness, H, Carmely, A et al. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Sci Transl Med, 2013;5(185):185ra62.Google Scholar
Edwards, BS, Isom, WJ, Navratil, AM. Gonadotropin releasing hormone activation of the mTORC2/Rictor complex regulates actin remodeling and ERK activity in LβT2 cells. Mol Cell Endocrinol, 2017;439:346–353.Google Scholar
Ataya, KM, McKanna, JA, Weintraub, AM, Clark, MR, LeMaire, WJ. A luteinizing hormone-releasing hormone agonist for the prevention of chemotherapy-induced ovarian follicular loss in rats. Cancer Res, 1985;45(8):3651–3656.Google ScholarPubMed
Bokser, L, Szende, B, Schally, AV. Protective effects of D-Trp6-luteinising hormone-releasing hormone microcapsules against cyclophosphamide-induced gonadotoxicity in female rats. Br J Cancer, 1990;61(6):861–865.Google Scholar
Ataya, K, Ramahi-Ataya, A. Reproductive performance of female rats treated with cyclophosphamide and/or LHRH agonist. Reprod Toxicol, 1993;7(3):229–235.CrossRefGoogle ScholarPubMed
Montz, FJ, Wolff, AJ, Gambone, JC. Gonadal protection and fecundity rates in cyclophosphamide-treated rats. Cancer Res, 1991;51(8):2124–2126.Google Scholar
Ataya, K, Rao, LV, Lawrence, E, Kimmel, R. Luteinizing hormone-releasing hormone agonist inhibits cyclophosphamide-induced ovarian follicular depletion in rhesus monkeys. Biol Reprod, 1995;52(2):365–372.CrossRefGoogle ScholarPubMed
Imai, A, Sugiyama, M, Furui, T, Tamaya, T, Ohno, T. Direct protection by a gonadotropin-releasing hormone analog from doxorubicin-induced granulosa cell damage. Gynecol Obstet Invest, 2007;63(2):102–106.CrossRefGoogle ScholarPubMed
Bildik, G, Akin, N, Senbabaoglu, F et al. GnRH agonist leuprolide acetate does not confer any protection against ovarian damage induced by chemotherapy and radiation in vitro. Hum Reprod, 2015;30(12):2912–2925.Google Scholar
Yüce, MA, Balkanli Kaplan, P, Gücer, F et al. Prevention of cyclophosphamide-induced ovarian damage by concomitant administration of GnRHa in mice: a dose-dependent relationship? Eur J Gynaecol Oncol, 2004;25(5):628–631.Google Scholar
Horicks, F, Van Den Steen, G, Houben, S, Englert, Y, Demeestere, I. Folliculogenesis is not fully inhibited during GnRH analogues treatment in mice challenging their efficiency to preserve the ovarian reserve during chemotherapy in this model. PloS One, 2015;10(9):e0137164.Google Scholar
Li, M, Huang, H, Liang, Y, Tan, J, Lin, D. Effect of zoladex administered before chemotherapy on menstruation of patients with breast cancer. Chinese J Clin Oncol, 2008;35:905–907.Google Scholar
Badawy, A, Elnashar, A, El-Ashry, M, Shahat, M. Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril, 2009;91(3):694–697.CrossRefGoogle ScholarPubMed
Sverrisdottir, A, Nystedt, M, Johansson, H, Fornander, T. Adjuvant goserelin and ovarian preservation in chemotherapy treated patients with early breast cancer: results from a randomized trial. Breast Cancer Res Treat, 2009;117(3):561–567.CrossRefGoogle ScholarPubMed
Gerber, B, von Minckwitz, G, Stehle, H et al. Effect of luteinizing hormone-releasing hormone agonist on ovarian function after modern adjuvant breast cancer chemotherapy: the GBG 37 ZORO study. J Clin Oncol, 2011;29(17):2334–2341.Google Scholar
Sun, J, Ren, Y, Li, W. Effect of zoladex administered before chemotherapy on menstruation of patients with breast cancer. China Dis Med, 2011;19:15–16.Google Scholar
Del Mastro, L, Boni, L, Michelotti, A et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA, 2011;306(3):269–276.Google ScholarPubMed
Munster, PN, Moore, AP, Ismail-Khan, R et al. Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. J Clin Oncol, 2012;30(5):533–538.CrossRefGoogle ScholarPubMed
Elgindy, EA, El-Haieg, DO, Khorshid, OM et al. Gonadatrophin suppression to prevent chemotherapy-induced ovarian damage: a randomized controlled trial. Obstet Gynecol, 2013;121(1):78–86.Google Scholar
Song, G, Gao, H, Yuan, Z. Effect of leuprolide acetate on ovarian function after cyclophosphamide-doxorubicin-based chemotherapy in premenopausal patients with breast cancer: results from a phase II randomized trial. Med Oncol, 2013;30(3):667.Google Scholar
Jiang, FY, Zhang, QQ, Zeng, J. Protective effect of GnRHa on chemo-therapy induced ovarian damage in breast cancer patients. Shandong Med J, 2013;53(8):16–18.Google Scholar
Karimi-Zarchi, M, Forat-Yazdi, M, Vafaeenasab, MR et al. Evaluation of the effect of GnRH agonist on menstrual reverse in breast cancer cases treated with cyclophosphamide. Eur J Gynaecol Oncol, 2014;35(1):59–61.Google Scholar
Moore, HCF, Unger, JM, Phillips, K-A et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med, 2015;372(10):923–932.Google Scholar
Lambertini, M, Boni, L, Michelotti, A et al. Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function, pregnancies, and disease-free survival: a randomized clinical trial. JAMA, 2015;314(24):2632–2640.Google Scholar
Leonard, RCF, Adamson, DJA, Bertelli, G et al. GnRH agonist for protection against ovarian toxicity during chemotherapy for early breast cancer: the Anglo Celtic Group OPTION trial. Ann Oncol, 2017;28(8):1811–1816.Google Scholar
Zhang, Y, Ji, Y, Li, J et al. Sequential versus simultaneous use of chemotherapy and gonadotropin-releasing hormone agonist (GnRHa) among estrogen receptor (ER)-positive premenopausal breast cancer patients: effects on ovarian function, disease-free survival, and overall survival. Breast Cancer Res Treat, 2018;168(3):679–686.CrossRefGoogle ScholarPubMed
Waxman, JH, Ahmed, R, Smith, D et al. Failure to preserve fertility in patients with Hodgkin’s disease. Cancer Chemother Pharmacol, 1987;19(2):159–162.Google Scholar
Giuseppe, L, Attilio, G, Edoardo, DN et al. Ovarian function after cancer treatment in young women affected by Hodgkin disease (HD). Hematol, 2007;12(2):141–147.Google Scholar
Behringer, K, Wildt, L, Mueller, H et al. No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group. Ann Oncol, 2010;21(10):2052–2060.Google Scholar
Demeestere, I, Brice, P, Peccatori, FA et al. Gonadotropin-releasing hormone agonist for the prevention of chemotherapy-induced ovarian failure in patients with lymphoma: 1-year follow-up of a prospective randomized trial. J Clin Oncol, 2013;31(7):903–909.Google Scholar
Demeestere, I, Brice, P, Peccatori, FA et al. No evidence for the benefit of gonadotropin-releasing hormone agonist in preserving ovarian function and fertility in lymphoma survivors treated with chemotherapy: final long-term report of a prospective randomized trial. J Clin Oncol, 2016;34(22):2568–2574.Google Scholar
Gilani, MM, Hasanzadeh, M, Ghaemmaghami, F, Ramazanzadeh, F. Ovarian preservation with gonadotropin-releasing hormone analog during chemotherapy. Asia Pac J Clin Oncol, 2007;3(2):79–83.Google Scholar
Clowse, MEB, Behera, MA, Anders, CK et al. Ovarian preservation by GnRH agonists during chemotherapy: a meta-analysis. J Womens Health 2002, 2009;18(3):311–319.Google Scholar
Ben-Aharon, I, Gafter-Gvili, A, Leibovici, L, Stemmer, SM. Pharmacological interventions for fertility preservation during chemotherapy: a systematic review and meta-analysis. Breast Cancer Res Treat, 2010;122(3):803–811.Google Scholar
Kim, SS, Lee, JR, Jee, BC et al. Use of hormonal protection for chemotherapy-induced gonadotoxicity. Clin Obstet Gynecol. 2010;53(4):740–752.Google Scholar
Bedaiwy, MA, Abou-Setta, AM, Desai, N et al. Gonadotropin-releasing hormone analog cotreatment for preservation of ovarian function during gonadotoxic chemotherapy: a systematic review and meta-analysis. Fertil Steril, 2011;95(3):906–914.e1-4.Google Scholar
Chen, H, Li, J, Cui, T, Hu, L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev, 2011;(11):CD008018.Google ScholarPubMed
Yang, B, Shi, W, Yang, J et al. Concurrent treatment with gonadotropin-releasing hormone agonists for chemotherapy-induced ovarian damage in premenopausal women with breast cancer: a meta-analysis of randomized controlled trials. Breast, 2013;22(2):150–157.CrossRefGoogle ScholarPubMed
Wang, C, Chen, M, Fu, F, Huang, M. Gonadotropin-releasing hormone analog cotreatment for the preservation of ovarian function during gonadotoxic chemotherapy for breast cancer: a meta-analysis. PloS One, 2013;8(6):e66360.Google Scholar
Zhang, Y, Xiao, Z, Wang, Y et al. Gonadotropin-releasing hormone for preservation of ovarian function during chemotherapy in lymphoma patients of reproductive age: a summary based on 434 patients. PloS One, 2013;8(11):e80444.Google Scholar
Sun, X, Dongol, S, Jiang, J, Kong, B. Protection of ovarian function by GnRH agonists during chemotherapy: a meta-analysis. Int J Oncol, 2014;44(4):1335–1340.Google Scholar
Del Mastro, L, Ceppi, M, Poggio, F et al. Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: systematic review and meta-analysis of randomized trials. Cancer Treat Rev, 2014;40(5):675–683.CrossRefGoogle ScholarPubMed
Vitek, WS, Shayne, M, Hoeger, K et al. Gonadotropin-releasing hormone agonists for the preservation of ovarian function among women with breast cancer who did not use tamoxifen after chemotherapy: a systematic review and meta-analysis. Fertil Steril, 2014;102(3):808–815.e1.Google Scholar
Elgindy, E, Sibai, H, Abdelghani, A, Mostafa, M. Protecting ovaries during chemotherapy through gonad suppression: a systematic review and meta-analysis. Obstet Gynecol, 2015;126(1):187–195.Google Scholar
Shen, Y-W, Zhang, X-M, Lv, M et al. Utility of gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage in premenopausal women with breast cancer: a systematic review and meta-analysis. OncoTargets Ther, 2015;8:3349–3359.Google Scholar
Lambertini, M, Ceppi, M, Poggio, F et al. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: a meta-analysis of randomized studies. Ann Oncol, 2015;26(12):2408–2419.CrossRefGoogle ScholarPubMed
Munhoz, RR, Pereira, AAL, Sasse, AD et al. Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early-stage breast cancer: a systematic review and meta-analysis. JAMA Oncol, 2016;2(1):65–73.Google Scholar
Silva, C, Caramelo, O, Almeida-Santos, T, Ribeiro Rama, AC. Factors associated with ovarian function recovery after chemotherapy for breast cancer: a systematic review and meta-analysis. Hum Reprod, 2016;31(12):2737–2749.CrossRefGoogle ScholarPubMed
Bai, F, Lu, Y, Wu, K et al. Protecting effects of gonadotropin-releasing hormone agonist on chemotherapy-induced ovarian damage in premenopausal breast cancer patients: a systematic review and meta-analysis. Breast Care, 2017;12(1):48–52.Google Scholar
Senra, JC, Roque, M, Talim, MCT, Reis, FM, Tavares, RLC. Gonadotropin-releasing hormone agonists for ovarian protection during cancer chemotherapy: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2018;51(1):77–86.Google Scholar
Hickman, LC, Llarena, NC, Valentine, LN, Liu, X, Falcone, T. Preservation of gonadal function in women undergoing chemotherapy: a systematic review and meta-analysis of the potential role for gonadotropin-releasing hormone agonists. J Assist Reprod Genet, 2018;35(4):571–581.CrossRefGoogle ScholarPubMed
Lambertini, M, Moore, HCF, Leonard, RCF et al. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta-analysis of individual patient-level data. J Clin Oncol, 2018;36(19):1981–1990.Google Scholar
Lambertini, M, Goldrat, O, Clatot, F, Demeestere, I, Awada, A. Controversies about fertility and pregnancy issues in young breast cancer patients: current state of the art. Curr Opin Oncol, 2017;29(4):243–252.Google Scholar
European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI, Webber, L, Davies, M et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod, 2016;31(5):926–937.Google Scholar
Meirow, D, Rabinovici, J, Katz, D et al. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer, 2006;107(7):1634–1641.Google Scholar

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