cetrorelix and Primary-Ovarian-Insufficiency

Cyclophosphamide treatment can cause premature ovarian failure. This pilot study evaluates the protective effect of the gonadotrophin releasing hormone (GnRH) antagonist, cetrorelix, on ovarian function, when used during cyclophosphamide chemotherapy in women aged 18-35. Primary outcomes measured were serum follicle stimulating hormone (FSH) and inhibin prior to and at 6 and 12 months after chemotherapy. Secondary outcomes were hormonal evidence of a suppressive effect and the side effect profile.

Topics: Adolescent; Adult; Antineoplastic Agents; Autoimmune Diseases; Breast Neoplasms; Cyclophosphamide; Female; Fertility Preservation; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Inhibins; Lymphoma; Organs at Risk; Ovary; Pilot Projects; Primary Ovarian Insufficiency; Young Adult

To determine if ovulation and pregnancy could be achieved in a case of amenorrhea, estrogen deficiency, and markedly elevated serum follicle stimulating hormone (FSH) through reduction of the serum FSH by a gonadotropin releasing hormone antagonist.. A 37-year-old woman with hypergonadotropic secondary amenorrhea related to two courses of chemotherapy with alkylating agents and abdominal radiation therapy (Hodgkin's disease and breast cancer) was treated with cetrorelix in an attempt to induce ovulation by lowering elevated serum FSH and hopefully restore sensitivity of the few remaining follicles by restoring down-regulated FSH receptors. She was monitored with serum estradiol (E2), FSH, luteinizing hormone (LH), progesterone (P) levels and sonography.. As the serum FSH dropped the serum E2 rose and peaked at 200 pg/ml after ten days of cetrotide. She conceived in that cycle. A viable ongoing pregnancy with appropriate ultrasound findings was demonstrated 40 days from conception.. This is the first case description of successful ovulation and pregnancy following induction of ovulation with the GnRH antagonist cetrorelix. The possibility exists that the ovulation was spontaneous but it seems unlikely. It has been estimated that the chance of spontaneous ovulation and pregnancy in cases of premature ovarian failure is 1:9,200.

Topics: Adult; Antineoplastic Agents; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Ovulation Induction; Pregnancy; Pregnancy Outcome; Primary Ovarian Insufficiency

Infertility represents one of the main sequelae of cytotoxic therapy given for various malignant diseases. Because dividing cells are more sensitive to cytotoxic effects than are cells at rest, it has been hypothesized that inhibition of the pituitary-gonadal axis may facilitate the preservation of future gonadal function. The aim of our study was to find a quick, reliable and economic way to suppress the pituitary-gonadal axis by combining GnRH-agonists with GnRH-antagonists in order to preserve future gonadal function.. A combination of D-Trp6-GnRH-a (3.75 mg) and cetrorelix (3 mg) was used to achieve a quick downregulation in six postmenarchal young women (aged 15.4 +/- 0.7) years with haematological malignancies before the onset of cytotoxic chemotherapy.. The combination of D-Trp6-GnRH-a and GnRH-antagonist cetrorelix induced a reliable and long-lasting suppression of gonadotrophin secretion within 96 hours in all patients allowing cytotoxic therapy to be started without any delay.. The combination of GnRH-agonist and GnRH-antagonist enables a rapid, reliable and cost-effective suppression of the pituitary-gonadal axis to be achieved. Future gonadal function of treated patients will be monitored.

Topics: Adolescent; Antineoplastic Agents; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Luteinizing Hormone; Primary Ovarian Insufficiency; Prospective Studies; Triptorelin Pamoate