Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in breast cancer patients

Since the survival of patients with cancer has significantly improved, chemotherapy-related premature ovarian failure (POF) in young cancer survivors has become a major issue in oncology. POF is associated with several health-related negative consequences, including menopausal symptoms, increased risk of cardiovascular diseases, osteoporosis, sexual dysfunction, and infertility. According to the major international guidelines, embryo/oocyte cryopreservation are the standard procedures for fertility preservation in young cancer women. However, these techniques do not protect the whole ovarian function from the gonadotoxicity of anticancer therapies; indeed, they can only preserve fertility without preventing POF and related side effects. In recent years, temporary ovarian suppression during chemotherapy with lutenising hormone-releasing hormone analogues (LHRHa) has emerged as an option to preserve both gonadal function and fertility. Despite temporary ovarian suppression with LHRHa showed to be an effective strategy to reduce the risk of treatment-related POF in several randomized clinical trials, its use as a standard procedure is still under debate. The present review will encompass the current evidences and controversies on the efficacy and safety of ovarian protection with LHRHa during chemotherapy for preservation of ovarian function and fertility in breast cancer patients, in light of the new data published.