GNRH AGONIST FOR CHEMOTHERAPY CAUSED PREMATURE OVARIAN INSUFFICIENCY IN YOUNG CANCER PATIENTS (META ANALAYSIS)

Fahmo Hussein Ibrahim, Prof. Xuefeng Wang*, Mohamed Siyad Mohamed, Fowzia Dahir Mohamed, Masud Adam Duale

ABSTRACT

Premature ovarian insufficiency indicated as the loss of ovarian follicles before the age of 40, is considered one of the most concerning long-term adverse effects of chemotherapy for cancer patients of reproductive age. Premature ovarian insufficiency is illustrated by primary amenorrhea (lack of menarche) and secondary amenorrhea (missed periods for month or longer). Symptoms of premature ovarian insufficiency include: low estradiol levels (measured once every four weeks), not being able to conceive or have periods for four months or more, hypoestrogenism, and elevated blood GnRH values, especially follicle-stimulating hormone and luteinizing hormone (>4 weeks apart) in the menopause range. Ovarian cancer is categorized as the development of cellular growth in the ovaries. The cells can get into healthy biological tissue, destroy it completely and quickly multiply there. Chemotherapy has high toxicity level to cause insufficiency of ovaries and the menopause. Utilizing gonadotropin-releasing hormone (GnRH) can result in safe and protective ovarian stimulation.GnRH analogues primarily replicate the pre-pubertal hormonal milieu by decreasing gonadotropin levels. GnRH-II can increase gonadotropin secretion (in vivo) by interacting with hGnRHR-I. The fact that hGnRH-I, hGnRH-II, and hGnRHR-I are expressed in tissues of mammary cancer supports the use of these molecules as BC therapeutic targets. A noteworthy distinction (statistically), the RR and CI are as follows: 95% CI=1.2-1.5, RR=1.3 and P=0.003. This shows that chemotherapy administered along with GnRHa may significantly speed up the restoration of menstrual function. GnRHa considerably accelerated the recovery of menstrual cycle. It decreases the velocity to recover the menstrual function and abridged the frequency of premature ovarian failure (POF). There is no effect on the possibility of being pregnant, endurance from tumor and general stability rates. However, not every woman with premature ovarian failure has a significant lack of menstruation or ovarian function. Ovarian function naturally changes with age, a process known as early menopause or menopause, which affects most women once they reach their forties. Menopause, the outcome of aging ovaries that eventually cease to produce eggs, often occurs between the ages of 50 and 55. Women of reproductive age who want to have children may struggle to accept a premature ovarian insufficiency (POI) diagnosis. Reproductive ambulatory care, such as fertility problems and birth controls, must be addressed as part of a comprehensive interdisciplinary treatment method of infertility and other reproductive issues. Unfortunately, to date, there is no curative therapy for premature ovarian insufficiency, while addressing the underlying causes may be able to reverse the illness and prevent further damage to the ovaries. In addition, 10 percent of women diagnosed with premature ovarian insufficiency go on to conceive a child without treatment. Some women may have what is known as "unexpected recovery" of premature ovarian insufficiency, in which their ovarian function returns to normal, fertility becomes fully recovered, and they are able to conceive regularly again. There is a great deal of potential in the future to learn more about the root cause of preterm ovarian failure, major health concerns related to premature ovarian insufficiency in the future will be a relevant research issue.

Keywords: Premature ovarian insufficiency, GnRH agonists, ovarian preservation, Chemoprotection, chemotherapy.