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 of 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.

STRUCTURED CLINICAL QUESTION

In young female patients with SLE undergoing CYC therapy [patient], does the use of GnRH-a [intervention], when compared to no intervention [comparison], prevent premature ovarian failure [outcome]?

SEARCH STRATEGY

[Lupus or Systemic lupus erythematosus] AND [cyclophosphamide] AND [gonadal toxicity or premature ovarian failure or fertility] AND [gonadotropin releasing hormone analogue or GnRH or GnRH-a] Limits: English, Human

Cochrane Library: None relevant

Medline: 1950–to date; EMBASE: 1974–to date; CINAHL: 1982–to date via Dialog DataStar

The search was conducted independently by both authors between December 2006 and January …