Does fertility return after completing a 6-month course of Lupron (leuprolide) for endometriosis?

From the Guidelines

Fertility typically returns to pre-treatment levels after completing a 6-month course of Lupron for endometriosis, as there is no evidence that such treatment affects the future fertility of women with endometriosis 1.

Key Points to Consider

• Lupron (leuprolide acetate) works by suppressing ovarian function, which is necessary for its effectiveness in treating endometriosis.
• After stopping the medication, it usually takes 1-3 months for normal ovarian function and menstrual cycles to resume, during which time fertility may be reduced.
• The endometriosis itself can also impact fertility, so it's essential to consider this when planning conception.
• According to the ACOG committee, current evidence suggests that pain caused by endometriosis can be managed medically, but no medical therapy has been proved to eradicate the lesions 1.

Recommendations for Fertility

• If you're planning to conceive, it's advisable to wait at least 2-3 months after completing Lupron treatment before trying to get pregnant, allowing time for the medication to clear from your system and for your natural hormonal cycles to regulate.
• Discuss your specific situation and fertility goals with your healthcare provider to determine the best timing for conception attempts after Lupron treatment.

Important Considerations

• Surgery for women with endometrial pain is associated with significant reduction in pain during the first six months following surgery, but up to 44 percent of women experience a recurrence of symptoms within one year 1.
• There are no data to indicate whether medical or surgical therapy results in better fertility outcomes, highlighting the need for individualized treatment plans and careful consideration of fertility goals.

From the FDA Drug Label

Normal function is usually restored within 4 to 12 weeks after treatment is discontinued.

Fertility Return: Fertility is likely to return after completing a 6-month course of Lupron (leuprolide) for endometriosis, as normal pituitary-gonadal function is usually restored within 4 to 12 weeks after treatment is discontinued 2.

From the Research

Fertility Return after Lupron Treatment

• The study 3 found that leuprolide acetate, a gonadotropin-releasing hormone (GnRH) analogue, is effective in treating endometriosis, but its recommended duration of use is limited to 6 months due to its effect on bone mineral density.
• Another study 4 demonstrated that treatment with Lupron Depot in children with central precocious puberty is safe and efficacious, and its effects are readily reversible after treatment is discontinued, with menarche occurring at a normal bone age.
• However, the study 5 on clouded leopards found that Lupron pre-treatments prevented ovulation in response to gonadotropin stimulation, suggesting that GnRH agonist therapy may alter ovarian sensitivity.
• A study on rats 6 found that Lupron given every 12 hours had a protective effect on fertility, but failed to protect fecundity, when used in combination with cyclophosphamide.

Reversibility of Lupron Treatment

• The study 4 found that girls who completed their course of treatment with Lupron Depot had pubertal gonadotropin responses to gonadorelin testing within 2 to 6 months, and menarche within the first year if skeletal maturation reached 13.0 to 13.5 years.
• This suggests that the effects of Lupron treatment on fertility may be reversible, but longer-term studies are needed to assess the potential effects on fertility 4.
• The study 7 found that treatment with Lupron and concomitant add-back therapies was associated with better adherence to and persistence with Lupron over the 6 months following initiation, compared with treatment with Lupron only.

Lupron Treatment and Fertility

• While the studies provide some insight into the effects of Lupron treatment on fertility, there is limited direct evidence on whether fertility returns after completing a 6-month course of Lupron for endometriosis.
• The available evidence suggests that Lupron treatment may have a reversible effect on fertility, but more research is needed to fully understand its impact on human fertility 3, 4.