Nationwide Survey of Institutional Factors Related to the Use of Gonadotropin‐Releasing Hormone Analogs for Ovarian Protection in Women Receiving Chemotherapy in Japan

AIM: This study aimed to investigate institutional factors associated with the clinical implementation of gonadotropin-releasing hormone (GnRH) analogs for ovarian protection in women receiving chemotherapy among fertility preservation facilities in Japan. METHODS: We conducted a nationwide, cross-sectional, web-based survey between May 1 and May 31, 2025, targeting all 172 medical facilities accredited by the Japan Society of Obstetrics and Gynecology (JSOG) as fertility preservation service providers. The questionnaire assessed institutional characteristics, awareness of the recommendation of GnRH agonists for ovarian protection, and current clinical use of GnRH analogs. Logistic regression analyses were performed to identify institutional factors associated with the use of GnRH agonists. RESULTS: A total of 128 facilities responded (response rate, 74.4%). Although 83.6% of facilities were aware of the recommendation of GnRH agonists for ovarian protection, only 26.6% reported experience using them. University hospitals (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 3.0-20.6; p < 0.001) and facilities with a full-time "oncofertility navigator" (aOR, 3.9; 95% CI, 1.3-13.6; p = 0.02) were more likely to report GnRH agonist use. Only 3.9% of facilities reported experience prescribing GnRH antagonists for ovarian protection, mainly in specific clinical situations such as urgent chemotherapy initiation or contraindications to GnRH agonists. Notably, 67.2% of responding facilities indicated that they would be more likely to use GnRH analogs for ovarian protection under the hypothetical condition that public insurance coverage were available. CONCLUSION: Despite high awareness of recommendations for GnRH agonists, the clinical implementation of GnRH analogs for ovarian protection remains limited in Japan. Institutional characteristics and policy-related factors were associated with reported GnRH agonist use, although causal relationships cannot be inferred. These findings highlight a gap between current clinical practice and available evidence and underscore the need for careful evaluation of the role of GnRH analogs within existing fertility preservation frameworks.