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Paper text:
the common malignancies in this age group involve the breast , cervix , blood and brain .
the long - term survival of all cancer patients has improved with the therapeutic advances in the oncology .
many of these patients will eventually show interest in childbearing , putting the burden of fertility preservation on the managing team .
the options available for fertility preservation include retrieval and cryopreservation of oocytes , ovarian tissue or embryo and ovarian suppression by the use of gonadotropin releasing hormone analogs ( gnrha ) .
primordial follicles at birth consistently reduce in life from closer to two million follicles at birth to 200,000 in reproductive age group .
female germ cells are incapable of regeneration after injury and hence it is important to preserve the available cells for future fertility .
initial studies revealed that the gonadotoxic chemotherapy had less damaging effects on ovarian function in prepubertal females .
the gnrha act by suppressing the pituitary ovarian axis decreased ovarian perfusion and prevents germ cell apoptosis .
other collateral benefits include suppression of menses and resulting prevention of anemia and bleeding in hematological malignancy .
parenting biologic children is dependent on factors like age of the patient , type of gonadotoxic therapy used ( radiation vs. chemotherapy ) , available time , specific disease and the fertility potential of the partner .
gnrha treatment is of doubtful efficacy for fertility . in women who have their normal menses and suffer from menorrhagia due to hematologic malignancies and
in one of the largest meta - analysis and systematic reviews , use of gnrha , was associated with spontaneous resumption of menses and ovulation , but no improvement in the rates of pregnancy .
since these receptors mediate functions like induction of cell cycle arrest , apoptosis inhibition and proliferation inhibition , it is possible that they may interfere with the action of chemotherapeutic drugs and thus reduce the efficacy of cancer treatment .
in addition , the efficacy of the use of gnrh agonist is not well established in clinical trials .
presently data is available for only resumption of menses and not for fertility so large data is required before prescribing this drug as adjuvant therapy for fertility preservation .
fertility rates are low with the use of gnrh treatment compared to other methods of ovarian function preservation .
this was due to small sample size , shorter study period , inadequate analyzable data and methodological weakness and also varied injection protocols in different studies .
chemotherapy induced infertility is a problem which is growing and often neglected . 
 fertility preservation strategy is an important component of the management in young patients with cancer . 
 gonadotropin releasing hormone analog therapy helps in ovarian suppression and the evidence is inconclusive for its benefit in fertility preservation . 
 other medical benefits with these drugs include reduction of vaginal bleeding in patients with thrombocytopenia .