***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer . METHODS An expert panel and a writing committee were formed . The questions to be addressed by the guideline were determined , and a systematic review of the literature from 1987 to 2005 was performed , and included a search of online data bases and consultation with content experts . RESULTS The literature review found many cohort studies , case series , and case reports , but relatively few r and omized or definitive trials examining the success and impact of fertility preservation methods in people with cancer . Fertility preservation methods are used infrequently in people with cancer . RECOMMENDATIONS As part of education and informed consent before cancer therapy , oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists . Clinician judgment should be employed in the timing of raising this issue , but discussion at the earliest possible opportunity is encouraged .  Sperm and embryo cryopreservation  are considered st and ard practice and are widely available ; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise . CONCLUSION Fertility preservation is often possible in people undergoing treatment for cancer . To preserve the full range of options , fertility preservation approaches should be considered as early as possible during treatment planning OBJECTIVE Cyclophosphamide ( CYC ) therapy for systemic lupus erythematosus ( SLE ) , a disease predominantly affecting women of childbearing age , causes an unacceptably high incidence of irreversible premature ovarian failure ( POF ) . This study was performed to evaluate the effectiveness of depot leuprolide acetate , a synthetic gonadotropin-releasing hormone analog ( GnRH-a ) , for protection against POF during CYC therapy . METHODS Young women with severe SLE treated in a st and ardized protocol of monthly intravenous bolus CYC were offered treatment with GnRH-a ( depot leuprolide acetate ; a 3.75-mg monthly injection during the st and ard CYC regimen ) . Patients treated with GnRH-a were compared with controls individually matched by age ( + /-5 years ) and by cumulative CYC dose ( + /-5 gm ) . Reproductive status was determined after a minimum followup of 3 years after CYC therapy . The primary outcome was time to POF . Paired summary statistical analyses , Kaplan-Meier survival estimates , and Cox regression analyses were performed to assess differences in outcome between groups . RESULTS POF developed in 1 of 20 women treated with GnRH-a ( 5 % ) compared with 6 of 20 controls ( 30 % ) matched by age and cumulative CYC dose ( matched odds ratio 0.09 , P < 0.05 ) . Kaplan-Meier estimates demonstrated improved cumulative ovarian protection over time in the GnRH-a-treated group ( P = 0.04 ) . CONCLUSION Treatment with GnRH-a during CYC therapy was associated with a significant reduction of POF in young women with severe SLE Ovarian reserve can be diminished following treatment for breast cancer . This study evaluated biochemical and biophysical parameters of ovarian reserve in these patients . Biochemical and biophysical tests of ovarian reserve were performed simultaneously in young ( age 22–42 years ) , regularly menstruating women with breast cancer ( n=22 ) and age-matched controls ( n=24 ) . All tests were performed before ( baseline ) and after transient ovarian stimulation in the early follicular phase . Patients were recruited both before and after completion of chemotherapy , with some patients being followed up prospect ively . Serum sample s were analysed for follicle-stimulating hormone ( FSH ) , luteinising hormone ( LH ) , oestradiol ( E2 ) , inhibins A and B , and antimullerian hormone ( AMH ) . Biophysical ( ultrasound ) tests included ovarian volume , antral follicle count ( AFC ) , ovarian stromal blood flow and uterine dimensions . Significant differences were revealed ( when compared with the controls ) for basal FSH ( 11.32±1.48 vs 6.62±0.42 mIU ml−1 , P<0.001 ) , basal AMH ( 0.95±0.34 vs 7.89±1.62 ng ml−1 , P<0.001 ) and basal inhibin B ( 19.24±4.56 vs 83.61±13.45 pg ml−1 , P<0.001 ) . Following transient ovarian stimulation , there were significant differences in the increment change ( Δ ) for inhibin B ( 3.02±2.3 vs 96.82±16.38 pg ml−1 , P<0.001 ) and E2 ( 107.8±23.95 vs 283.2±40.34 pg ml−1 , P<0.01 ) . AFC was the only biophysical parameter that was significantly different between patients and the controls ( 7.80±0.85 vs 16.77±1.11 , P<0.001 ) . Basal and stimulated biochemical ( serum AMH , FSH , inhibin B and E2 ) and biophysical ( AFC ) tests may be potential markers of ovarian reserve in young women with breast cancer Objective . To explore the effects of a gonadotropin-releasing hormone ( GnRH ) agonist depot ( goserelin acetate ) in women with Hodgkin 's disease receiving chemotherapy while taking a continuous combined estrogen – progestin preparation as add-back on the prevention of premature ovarian failure ( POF ) . Methods . In a prospect i ve pilot study , five premenopausal women with Hodgkin 's disease received a GnRH agonist depot plus add-back until polychemotherapy was completed . Every 4 weeks during treatment and thereafter , a hormonal profile ( follicle-stimulating hormone ( FSH ) , luteinizing hormone , 17β-estradiol , progesterone and inhibin B ) was measured until resumption of menstruation or the development of a hypergonadotropic state ( 2 × FSH > 30 U/l ) . Results . All patients reached prepubertal status during treatment . After discontinuation of goserelin acetate , one patient developed a hypergonadotropic state and four patients resumed menstruation . One of those patients became pregnant and delivered a healthy son . Conclusions . The effectiveness of GnRH agonist plus add-back on the prevention of POF during polychemotherapy in women with Hodgkin 's disease needs further elucidation in r and omized controlled trials . The results of our pilot study are promising BACKGROUND St and ard methods to prevent chemotherapy-induced early menopause in young , breast cancer patients are unavailable to date . Pre clinical data has suggested that luteinising hormone-releasing hormone ( LH-RH ) analogs given during treatment can decrease the gonado-toxicity induced by chemotherapy . This phase II study aim ed to assess the activity of such a method in young , breast cancer patients undergoing adjuvant chemotherapy . PATIENTS AND METHODS Premenopausal patients received the LH-RH analog goserelin 3.6 mg every 4 weeks before and during chemotherapy . According to two-stage optimal phase II Simon design , treatment was considered clinical ly interesting if it was able to prevent menopause in 19 out of 29 patients of the study population . The resumption of ovarian function was defined by a resumption of menstrual activity or by a follicle-stimulating hormone ( FSH ) value < or = 40 IU/l within 12 months after the last cycle of chemotherapy . RESULTS Thirty patients were enrolled and 29 were evaluable . Median age was 38 years ( range 29 - 47 ) . All but one patient received CEF regimen ( cyclophosphamide , epirubicin , 5-fluorouracil ) .  Resumption of menstrual activity was observed in 21 patients ( 72 % ; 95 % CI 52 % to 87 % ) and a FSH value < or = 40 IU/l in 24 patients ( 83 % ; 95 % CI 63 % to 93 % ) . Menses resumption was observed in 16 out of 17 patients ( 94 % ) with age < 40 years and in five out of 12 patients ( 42 % ) with age > or = 40 years . CONCLUSION Goserelin given before and during chemotherapy may prevent premature menopause in the majority of patients . The different success rate by age , however , indicates the need of a prospect i ve evidence of the efficacy of such a strategy BACKGROUND Intensive chemotherapy is widely used to improve the outcome of aggressive non-Hodgkin lymphoma ( NHL ) . Since these regimens may cause premature ovarian failure ( POF ) , the ovarian function was studied in 13 consecutive women aged < or = 40 years , treated with four cycles of intensified CHOP ( cyclophosphamide 2000 - 3000 mg/m2 per cycle doxorubicin 50 mg/m2 , vincristine 1.4 mg/m2 ( maximum 2 mg ) and prednisone 100 mg/day were given every 3 weeks ) . METHODS Patients aged < 60 years with aggressive NHL were eligible for participating in a non-r and omized phase II study if they had stage I , II , B , bulky , or stages III , IV disease with the age-adjusted international prognostic index of low-intermediate to high-risk score . Seven patients were concomitantly treated with D-TRP6-GnRH analogue ( Decapeptyl ; Ferring , Germany ) for minimizing gonadal toxicity . RESULTS With a median follow-up of 70 months only one patient had POF , while 12 patients retained fertility and eight conceived spontaneously delivering 12 healthy babies . CONCLUSION It appears that high-dose cyclophosphamide does not affect the ovarian function or fertility in patients exposed to this medication during four consecutive cycles of intensified CHOP BACKGROUND The reduction of treatment-related toxic effects is the main goal in the current trials of the German Hodgkin Study Group ( GHSG ) . In this regard , the protection of the ovarian reserve in young women is very important . Therefore , the GHSG investigated the use of gonadotropin-releasing hormone-analogues ( GnRH-a ) and oral contraceptives ( OC ) in young women with advanced-stage Hodgkin lymphoma ( HL ) . PATIENTS AND METHODS Women ( 18 - 40 years ) were r and omly assigned either to receive daily OC or monthly GnRH-a during escalated combination therapy with bleomycin , etoposide , adriamycin , cyclophosphamide , vincristine , procarbazine , and prednisone ( BEACOPPesc ) . Hormonal levels were determined at baseline , during therapy , and at follow-up . RESULTS The study was closed prematurely after an interim analysis of 12 patients in arm A ( OC ) and 11 in arm B ( GnRH-a ) , 9 and 10 are assessable for the primary end point . Women 's median age was 25 years in both arms . The anti-Mullerian hormone level after at least 12 months was reduced in all patients . For the entire study cohort , the respective ovarian follicle preservation rate was 0 % ( 95 % confidence interval 0 % to 12 % ) . CONCLUSION We observed no protection of the ovarian reserve with hormonal co-treatment during BEACOPPesc . This result supports efforts of ongoing trials to reduce chemotherapy intensity and toxicity . Alternative strategies for the protection of fertility must be offered to young female HL patients before the start of BEACOPPesc therapy Summary The hypothesis that the “ down-regulated ” gonad is less vulnerable to the effects of cytotoxic chemotherapy for advanced Hodgkin 's disease has been investigated . Thirty men and eighteen women were r and omly allocated to receive an agonist analogue of gonadotrophin-releasing hormone prior to , and for the duration of , cytotoxic chemotherapy . Buserelin ( d-Ser-[TBU]6 LHRH ethylamide ) was prescribed in two different dosage schedules to twenty men , and in a single dosage schedule to eight women . A st and ard gonadotrophin-releasing hormone test ( GnRH 100 μg ) was performed 1 week prior to and on day 1 of each cycle of chemotherapy . In all patients peak luteinizing hormone responses to GnRH were suppressed throughout treatment . The higher of the two dosage schedules used in the men caused more effective suppression of luteinizing hormone , and both regimens led to an initial suppression of peak follicle-stimulating hormone responses to GnRH , which was not maintained . At followup assessment up to 3 years from the completion of treatment , all men treated with buserelin were profoundly oligospermic and four of the eight women were amenorrhoeic . All ten male controls were profoundly oligospermic , and six of nine female controls were amenorrhoeic . In the dosages and schedules investigated , buserlin was ineffective in conserving fertility The purpose of this r and omized study was to examine if goserelin 
    Output:
    
Pregnancy rate was higher in the GnRHa arm .
The advantage of GnRHa was shown only in observational studies , but not in r and omized controlled trials .
Biomarkers for ovarian reserve were similar in both arms .
Studies evaluating the efficacy of oral contraceptives in preserving ovarian function showed inconclusive results .
GnRHa appears to improve menstruation resumption .
Nevertheless , r and omized prospect i ve trials are less conclusive for their real value in conserving ovarian reserve and pregnancy .