Failure of ovarian suppression with gonadotropin-releasing hormone analogs to preserve fertility: An assessment based on the quality of evidence
A partir d'une revue systématique de la littérature publiée entre 1975 et 2015 (7 études), cette méta-analyse fait le point sur l'efficacité d'un traitement par agonistes de l'hormone de libération des gonadotrophines (GnRHa) pour préserver la fonction ovarienne chez des patientes atteintes d'un cancer du sein de stade précoce et recevant une chimiothérapie
The proximate cause of menopause, whether natural or induced, is ovarian primordial follicle oocyte reserve depletion. This reserve is established in utero and cannot be replenished. Specific chemotherapeutics, particularly alkylating agents and topoisomerase inhibitors, induce DNA double strand breaks in primordial follicle oocytes, thereby triggering apoptotic death.1 It is by this reduction of the ovarian follicle reserve that the reproductive life span is shortened and menopause is facilitated. Ovarian failure is the last manifestation of chemotherapy-induced infertility. Hence, ovarian follicle depletion and infertility due to cancer treatments are not independent processes.
JAMA Oncology , commentaire, 2014