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Adjuvant gonadotropin‐releasing hormone analogues for chemotherapy induced premature ovarian failure in premenopausal women

Chemotherapy has significantly improved the prognosis for patients with cancer and some non‐cancerous conditions. This treatment, however, is associated with ovarian toxicity. Factors which may affect the risk level of chemotherapy‐induced ovarian damage include the patient's age and type of chemotherapy regime. Gonadotropin‐releasing hormone (GnRH) analogues, which are artificial hormone derivatives, can protect the ovaries by suppressing the gonadotrophin hormone, which stimulates ovary function and decreases blood flow, making them less sensitive to the chemotherapy drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gonadotropin‐releasing hormone agonist versus HCG for oocyte triggering in antagonist‐assisted reproductive technology cycles

We reviewed the evidence on the effects of GnRH agonists on final oocyte maturation triggering in GnRH antagonist IVF/ICSI treatment cycles.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Both hormone replacement therapy and danazol stop the loss of bone density that occurs when women take gonadotrophin‐releasing hormone analogues for endometriosis

Endometriosis is a painful condition caused where tissue from the lining of the uterus (womb) is outside the uterus as well. It can be treated with gonadotrophin‐releasing hormone analogues (GnRHas). Possible adverse effects of GnRHas include loss of bone density, loss of sex‐drive and hot flushes. The decrease in bone density is particularly important because it increases the risk of osteoporosis. The review found that taking hormone replacement therapy with GnRHas can prevent this adverse effect. Danazol can also prevent loss of bone density, but adverse effects of danazol can include acne, weight gain and headaches.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Gonadotrophin‐releasing hormone agonist for improving fertility

Women undergoing in vitro fertilisation (IVF) need to take a series of hormones. The use of the drug GnRHa (gonadotrophin‐releasing hormone agonist) during one stage of this process increases the chance of pregnancy. There are several options for GnRHa use. Long courses of GnRHa can be given either as daily low‐dose injections, or using a single higher‐dose longer‐acting injection (depot version). The review of 16 randomised controlled trials found no evidence that depot versus daily GnRHa injections produce different rates of live birth/ongoing pregnancy, clinical pregnancy or ovarian hyperstimulation syndrome (OHSS). However, substantial differences could not be ruled out. For example, for a woman with a 25% chance of achieving a live birth or ongoing pregnancy using GnRHa depot, the corresponding chance using daily injection would be between 16% and 30%. For a woman with a 25% risk of severe OHSS using GnRHa depot, the corresponding risk using daily injection would be between 4% and 89%. For a woman with a 25% chance of achieving a live birth or ongoing pregnancy using daily GnRHa injections, the corresponding chance using a depot injection would be between 19% and 30% . For a woman with a 25 % chance of severe OHSS using daily GnRHa injections, the corresponding chance using GnRHa depot would be between 9 % and 45 % . Depot GnRHa may increase the cost of an IVF cycle, because it lengthens the period to ovulation and requires the use of higher doses of other hormone drugs. The quality of the studies was unclear due to poor reporting, and only four studies reported live births.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Gonadotrophin‐releasing hormone analogues for pain associated with endometriosis

 Endometriosis is a common condition affecting women of child‐bearing age, and is usually due to the presence of endometrial tissue in places other than the uterus. Common symptoms include pain and infertility. GnRHas are a group of drugs often used to treat endometriosis by decreasing hormone levels. This review found evidence to suggest treatment with a GnRHa improved symptom relief compared with no treatment or placebo. There was no evidence of a statistically significant difference when compared with danazol or intra‐uterine progestagen. However, there more side effects in the GnRHa group compared with the danazol group. There is not enough evidence to make clear if higher or lower doses of GnRHa are better, or which length of treatment is best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Pulsatile gonadotrophin releasing hormone for ovulation induction in subfertility associated with polycystic ovary syndrome

Women with polycystic ovary syndrome have menstrual disorders caused by the absence of ovulation. About 20% of women will not ovulate on clomiphene citrate, the primary treatment option. These women can be treated with a surgical procedure like laparoscopic electrocautery of the ovaries or by ovulation induction with gonadotrophins or gonadotrophin releasing hormone (GnRH). In normal menstrual cycles, GnRH is released in a regular pulsatile interval. A portable pump can be used to mimic this pulse to help these women to ovulate and hopefully to get pregnant. The review of trials did not find enough evidence to show the effectiveness of pulsatile GnRH in women with polycystic ovary syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Chemotherapy for men with prostate cancer who have not responded to hormone therapy

Men with advanced prostate cancer and painful bone metastases are a difficult group of patients to treat. Data from recent randomised trials of chemotherapy suggest an improvement in overall survival, pain relief, and quality of life with this form of therapy. Side effects are common and can be severe. Chemotherapy offers a treatment option for men with hormone‐refractory prostate cancer (HRPC), but the decision to treat should be carefully considered by the patient and clinician. More studies are needed to find new and better agents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Gonadotrophin‐releasing hormone agonists (GnRHa) used as an adjuvant to gonadotrophins in assisted reproduction treatments

Researchers from the Cochrane Collaboration reviewed the evidence about the most effective way of using gonadotrophin‐releasing hormone agonists (GnRHa) as part of controlled ovarian stimulation in women undergoing assisted reproduction technology (ART).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gonadotrophin‐releasing hormone antagonists versus GnRH agonist in subfertile couples undergoing assisted reproductive technology

This updated Cochrane review evaluated the efficacy and safety of GnRH antagonists compared to the more widely‐used GnRH agonists (long‐course protocol).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Endometrial preparation for egg donor recipients or for frozen embryo transfers

Couples undergo in vitro fertilisation (IVF) after a long period of subfertility, because women have blocked fallopian tubes or severe endometriosis, where the male partner has a reduced semen count, or when pregnancy has not resulted after previous less invasive fertility treatment. Subsequent to an unsuccessful fresh embryo IVF cycle, a frozen‐thawed embryo transfer can be performed when frozen embryos are available. Alternatively for women who have:ovarian insufficiency (premature menopause), poor ovarian capacity to respond to stimulation, or or have had several unsuccessful IVF cycles, oocyte donation is a frequent treatment option, particularly for older women. Adequate hormonal preparation of the endometrium is of outmost importance in both egg donor and frozen embryo replacement cycles to provide the optimal chances of pregnancy. Many drugs and various modes of administration have been tried by several investigators in order to optimise implantation rates and consequently improve the success rates of the embryo transfer procedures. A total of 22 randomised controlled trials were included in this review. There is insufficient evidence from these trials to be able to identify one particular intervention for endometrial preparation that clearly improves the treatment outcome for women receiving embryo transfers with either frozen embryos or embryos derived from donated oocytes. Better quality studies are needed to more accurately evaluate each treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Herbal preparations for the treatment of women with uterine fibroids

Uterine fibroids are benign (non‐cancerous) growths in the uterus. They are the most common type of growth found in a woman's pelvis, being present in about one in four or five women older than 35 years. Although many women with fibroids are not aware of them, the growths may cause symptoms or problems due to their size, number, or location. Common symptoms can include longer or more frequent menstrual periods, heavy bleeding, menstrual pain, pressure in the lower abdomen, infertility, or miscarriages. Women with these symptoms may require treatment. Fibroids can be treated with surgery, such as myomectomy (removal of the fibroids while leaving the uterus in place) or hysterectomy (removal of the uterus). Another approach is uterine artery embolization, by which the blood vessels to the uterus are blocked. Drugs such as gonadotropin‐releasing hormone (GnRH) agonists may be used to shrink fibroids and to control bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

This review concludes that there is insufficient evidence to support the use of one menstrual cycle regimen over another in frozen‐thawed embryo transfer (FET).

Women with regular spontaneous cycles may be offered any of the cycle regimens to prepare the womb lining for FET. If artificial cycles are used there is some evidence to support the use of an additional drug that suppresses hormone production by the ovaries (gonadotrophin releasing hormone agonist (GnRHa)). There is a need for additional well‐designed studies to be performed, to determine whether a specific cycle regimen is linked with higher pregnancy and live birth rates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Use of a levonorgestrel‐releasing intrauterine device (LNG‐IUD) for recurrence of symptoms in women who have had surgery for endometriosis

Endometriosis is the presence of endometrial tissue outside the uterus, usually in the pelvis, that can lead to infertility and pelvic pain. It is managed with surgery, hormonal medications, or a combination of both. The progestogen levonorgestrel is one such hormonal medication. The aim of this review was to assess whether the use of a hormone‐releasing intrauterine device was beneficial for managing associated painful symptoms and for preventing recurrence of endometriosis following surgery. Although preliminary findings are encouraging, at this stage there is only limited evidence from three randomised trials of a beneficial role with the use of the LNG‐IUD in reducing the recurrence of painful periods following surgery for endometriosis. The strength of the evidence was graded as moderate reflecting our belief that future evidence will most likely not change these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pre‐treatments in IVF/ICSI cycles

In vitro fertilisation (IVF) and intra cytoplasmic sperm injection (ICSI) are important techniques for women who have trouble getting pregnant. IVF and ICSI cycles consist of a few steps. First the woman receives hormone therapy to stimulate her ovaries in producing egg cells. When a few egg cells are mature enough to be fertilized, the woman receives a single hormone injection. This triggers the ovaries to release the egg cells, so they can be gathered by the clinician. The eggs are then fertilised outside the woman's body and become embryos. At last one or two embryos are transferred into the womb.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for women with endometrioma prior to assisted reproductive technology

Endometriomata are a form of ovarian endometriosis, classified as cysts within the ovaries. They are a common cause of subfertility and pelvic pain. This review aimed to determine which treatment approach was better for women with subfertility and endometriomata who were undergoing assisted reproductive technology (ART). Four trials were identified. A gonadotropin‐releasing hormone (GnRH) agonist showed a positive treatment effect on the ovarian response to controlled ovarian hyperstimulation (COH) and the number of mature oocytes retrieved compared to GnRH antagonist. The evidence for surgery was limited but aspiration was associated with a greater ovarian response than expectant management (a wait and see approach). Further randomised controlled trials of interventions for the management of endometrioma in women undergoing ART are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Use of clomiphene citrate in IVF treatment

Gonadotrophin injections are commonly used in an IVF treatment to stimulate the ovaries to increase the number of available eggs, which can then be mixed with sperm in the laboratory to create embryos for transfer back into the uterus. However, the injections are expensive, inconvenient and are associated with side effects. Calls for patient friendly stimulation regimens have generated interest in using clomiphene, which is a tablet, in these treatments to reduce the burden of injections. Presently it is not known whether use of clomiphene is associated with similar pregnancy rates. The aim of this review was to compare regimens with clomiphene versus gonadotropins alone for stimulation of the ovaries during IVF treatment. A total of 12 studies, with 2536 participants, were included in the analysis. The evidence from this review suggests that use of clomiphene along with gonadotropins leads to similar pregnancy rates as those occurring after the use of gonadotropins alone. However, the evidence was limited as all studies included in this review were old. Further evidence is required to determine the clinical and cost effectiveness of stimulation regimens using clomiphene citrate with gonadotropins versus gonadotropins alone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Pre‐operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids

Smooth muscle tumours of the uterus (uterine fibroids)are usually asymptomatic, however up to 50% cause symptoms severe enough to warrant therapy, and surgery is the standard treatment. Fibroid growth is stimulated by the hormone oestrogen and gonadotropin releasing hormone agonists (GnRHa). GnRHa treatment causes fibroids to shrink but cannot be used long term because of side effects and bone loss.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Progestagens and anti‐progestagens for pain associated with endometriosis

Endometriosis is a painful condition where tissue from the lining of the womb (uterus) is found outside the uterus as well. It can cause pain in the abdomen, generally and during periods (menstruation) or sex. Endometriosis can also lead to infertility. Treatments include surgery or drugs to try and shrink the tissue. Progestagens and anti‐progestagens are some of the hormonal drugs used for treatment. This systematic review of trials found limited evidence for the effectiveness of these drugs in the reduction of pain from endometriosis. This was due to the limited number of randomised controlled trials comparing each drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Long‐term pituitary down‐regulation before in vitro fertilization (IVF) for women with endometriosis

Endometriosis is a disease characterised by the presence of endometrial tissue (the lining of the womb) outside the cavity of the womb. Many women with the disease suffer from menstrual pain and some suffer from infertility. Infertile women with endometriosis are often treated with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) but have a lower chance of becoming pregnant compared to women who are infertile with blocked tubes. It has been suggested that giving GnRH agonists before IVF or ICSI could increase the chances of pregnancy. We have reviewed the literature and found that treating women for three to six months with GnRH agonists before IVF or ICSI increases the odds of clinical pregnancy four‐fold. However, at present there is no information on the effect of this treatment on the incidence of ectopic pregnancy, multiple pregnancies or complications arising for the women or their offspring.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

What is the best timing technique for intrauterine insemination in subfertile couples

Review question. Cochrane authors reviewed the evidence about the effectiveness of different timing techniques for intrauterine insemination in subfertile couples.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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