Is Zolodex Intake Necessary For Fertility After Finishing Chemotherapy?

Posted on Sat, 11 Jan 2014

Question: My wife completed fourth and final cycle of chemo on Dec 6 and she has been receiving zolodex shot every 4 weeks and is scheduled for last shot on 26 Dec. She is wondering if the final zolodex shot is necessary considering her final cycle of chemo comprised only docataxel and not cyclophosphamide which was included for other cycles? She is due to start radiation XXXXXXX 7. She was diagnosed with multi focal invasive ductal carcinoma. She requested zolodex to give her a chance of keeping fertility since she is in early 40s and oncologist went along with request. basically, wondering if zolodex necessary since chemo finished 3 weeks ago so may not need the protective effect of zolodex or should it be taken to keep estrogen levels low, since her cancer is er+? Thanks.XXXX

Answered by Dr. Krishna Kiran Kannepalli (4 hours later)

Brief Answer: I think it is better to give than not to. Detailed Answer: Hi. Thanks for the query. I did not understand why cyclophosphamide was excluded from the last cycle. Anyways, since her tumor is ER positive and she is premenopausal she will require a combination of zoladex and tamoxifen for hormonal treatment. So continuing zoladex is in fact beneficial as it serves two purposes. Ovarian preservation and ovarian suppression as is done for ER positive cancers. While planning kids in the future you need to take into account these things and having a realistic understanding of the pros and cons of having a pregnancy and discuss it with a infertility expert. For now continuing zoladex is a good option. Hope this answers your query, please write back if you have any doubts. Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Krishna Kiran Kannepalli (7 hours later)

Hi Dr XXXXXXX Thanks for the reply. What you wrote is clear. A concern for my wife is that taking zolodex longer than necessary may negatively effect either fertility or return of menses. From what her oncologist has said and what I have read, cyclophosphamide is the greater danger to ovarian reserves and is one reason zolodex was given to my wife during chemo. And so, in your opinion, is it possible that zolodex could reduce ovarian function if taken after the cyclophosphamide is out of her system? I understand the zolodex will assist in controlling estrogen which is great for an ER+ cancer, but have any trials been done on the effect of zolodex on fertility/ovarian function in the absence of chemo? Thanks for your time.XXXX

Answered by Dr. Krishna Kiran Kannepalli (1 hour later)

Brief Answer: Zoladex does not deplete ovarianresrvepermanently Detailed Answer: Thanks for the query. Zoladex acts only for 3 months during which it causes ovarian suppression by inhibiting the hypothalamic pituitary ovarian axis. It does not deplete ovarian reserves. It therefore has no long term deleterious effects on fertility. It is infact used for a short time before ovarian stimulation in some IVF protocols. As far as ovarian suppression for ER positive tumors is considered, use of zoladex is optional in the adjuvant setting (as per NCCN guidelines). In your case therefore it can be skipped. However taking a dose of zoladex now is appropriate and will probably do more good than harm.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj