Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy?
A 15 year old girl with acute renal failure was found to have class IV systemic lupus erythematosus (SLE) nephritis on renal biopsy. A decision was taken to start her on the routine National Institute Health protocol of pulsed methyl-prednisolone and monthly intravenous cyclophosphamide (CYC) (0.5–1.0 g/m2 of body surface area). With her post pubertal status and the possibility of CYC induced gonadal toxicity, the question was raised as to whether she should be put on gonadotropin releasing hormone analogue ( GnRH-a ) therapy for ovarian protection.
It’s probably a while since you last thought of fertility issues in respect of your patients, but as more and more teenage and young adult patients come under the caring hands of paediatric doctors, it’ll be a nudge to relearn all the O&G you missed in medical school. What about those patients who receive alkylating agents, which may affect their fertility, and the options available for them? In young men, sperm banking is a option (although sadly not widely offered to the most obvious group – teenagers and young adults with a new cancer diagnosis according to this paper), but for women the options are more scarce.
The answer – as judged by the authors below – can be found here. Do you agree?
Dr Rajiv Sinha (Fellow, Paediatric Nephrology) and Dr Janis M Dionne (Clinical Assistant Professor, Paediatric Nephrology) from British Columbia’s Children’s Hospital, Vancouver.