Chemotherapeutic drugs are detrimental to ovarian function, and GnRHa is commonly used clinically to protect the ovaries in young patients undergoing chemotherapy.GnRHa inhibits follicular development, preventing chemotherapeutic drugs from poisoning the follicles, and thus protecting the ovaries. It’s all very nice to think about, but is it true? Chemotherapeutic drugs destroy tumor cells, but also have damage to normal organs, and the ovaries are one of the victims. Clinical manifestations can be amenorrhea, premature ovarian failure, infertility and so on. The more mature follicles in the ovary are more actively divided than the primitive follicles and are more damaged by chemotherapy drugs. Studies have shown that the number of primordial follicles in the ovaries of women receiving chemotherapy is normal to mildly reduced, while the number of more mature follicles is significantly reduced. Several months after stopping chemotherapy, new primordial follicles develop into functional follicles and the patient’s menstruation and fertility are restored. The degree of ovarian damage is related to the type and dose of drug, the patient’s age and individual differences. The effects of different drugs on ovarian function vary widely. The following table lists some of the commonly used chemotherapeutic drugs that are toxic to the ovaries. Among them, alkylating agents have the strongest effect on the ovaries, such as cyclophosphamide. Age is another important factor in the influence of chemotherapeutic agents causing damage to ovarian function. There is a misconception that ovarian damage is more pronounced in younger women, which is not true. The reason that younger women’s ovaries are less affected by chemotherapy drugs than older women is that younger women have more primordial follicles in their ovaries, which are less likely to be damaged during chemotherapy. Studies have shown that all women over the age of 40 experienced amenorrhea after receiving greater than 5.2 g of cyclophosphamide, while the dose of the drug needed to cause amenorrhea in younger women was 9.5 g. The older the chemotherapy patient, the higher the chance of premature ovarian failure. Thus, older patients appear to have a greater need for ovarian protection. In addition, there are differences in susceptibility to chemotherapeutic drugs in different patients. After using the same drugs, some women have unaffected ovarian function, while others of the same age develop amenorrhea or premature ovarian failure. Chemotherapeutic drugs are damaging to the ovaries and protecting ovarian function is on the agenda when chemotherapy has to be administered. The main function of the ovaries is to produce eggs and secrete hormones. For infertile patients, the main purpose of protecting the ovaries is to preserve fertility; for patients without fertility requirements, the purpose of protecting the ovaries is to restore menstruation and preserve the endocrine function of the ovaries. In terms of pharmacological protection of the ovaries, the first thing that comes to mind is the use of GnRHa to inhibit follicular development and division and reduce follicular damage. Animal experiments have confirmed that GnRHa reduces the risk of chemotherapy-induced ovarian damage. However, in human trials, both the efficacy and safety aspects of GnRHa for preventing ovarian toxicity are controversial. A 2011 systematic evaluation synthesized 28 clinical trials to assess the protection of ovarian function in patients treated with chemotherapy concurrent with GnRHa, evaluating the following three main metrics: incidence of premature ovarian failure, menstrual recovery, and pregnancy rate after chemotherapy. The use of GnRHa was found to be helpful in restoring ovulation and menstruation, but had no effect on the pregnancy rate after chemotherapy. a 2013 study of lymphoma patients found that anti-mullerian hormone (AMH, which evaluates ovarian reserve function) was higher in patients using GnRHa, but that the use of GnRHa or not did not change the incidence of premature ovarian failure. In addition, the safety of GnRHa use in cancer patients has not been established. Studies in breast cancer suggest that breast cancer tissues express GnRH receptors and that such receptors mediate a variety of effects, such as inhibition of cell proliferation.GnRHa may reduce the efficacy of chemotherapy in patients who are GnRH receptor positive. In women who are hormone receptor negative, GnRHa inhibition therapy may be safer. Brief summary. Based on the data from the current study, in terms of preserving ovarian function in chemotherapy patients, GnRHa helps to preserve ovarian reserve function, restore ovulation and reestablish the menstrual cycle, but does not contribute to the long-term goal of preserving the ovaries-improving fertility and pregnancy rates. Therefore, the routine use of GnRHa to protect ovarian function in chemotherapy patients is not currently recommended. The results of these studies seem to be inconsistent in that GnRHa protects ovarian reserve function, and it is only right that fertility should increase accordingly! The reasons for this are: first, there is still a long way to go before ovarian reserve function is converted into pregnancy, and the ovaries are only one part of the pregnancy process, which depends on many other factors; second, there is a lack of relevant clinical research samples. Secondly, there is a lack of relevant clinical research samples. There are very few research subjects who can meet the conditions of needing chemotherapy for malignant tumors, using GnRHa at the same time, and having fertility requirements. In addition, the follow-up time of such studies can only be calculated in years, which increases the difficulty of data collection, so it makes sense that no definitive conclusions can be drawn. This is the characteristic of clinical research, using data to speak, before the exact data, can not be “taken for granted” or by logical reasoning to establish clinical practice. Since GnRHa is not effective, is there a better way to protect the ovaries? Yes, cryopreservation! If there is a lack of effective cryopreservation technology and the patient has a strong desire to protect ovarian function, is there no alternative available to us? In the author’s opinion, GnRHa can be used under the premise of adequate patient-doctor communication, and for premenopausal women using chemotherapy drugs with high ovarian toxicity, the use of GnRHa can be initiated 1 week to 2 months prior to the start of chemotherapy and continued until the end of chemotherapy.