THERAPY OF ENDOCRINE DISEASE: Novel protection and treatment strategies for chemotherapy-associated ovarian damage

Abstract

Fertility and ovarian protection against chemotherapy-associated ovarian damage has formed a new field called oncofertility, which is driven by the pursuit of fertility protection as well as good life quality by numerous female cancer survivors. However, the choice of fertility and ovarian protection method is a difficult problem during chemotherapy and there is no uniform guideline at present. To alleviate ovarian toxicity caused by anticancer drugs, effective methods combined with individualized treatment that integrate an optimal strategy for preserving and restoring reproductive function should be offered from well-established to experimental stages before, during, and after chemotherapy. Although embryo, oocyte, and ovarian tissue cryopreservation are the major methods that have been proven effective and feasible for fertility protection, they are also subject to many limitations. Therefore, this paper mainly discusses the future potential methods and corresponding mechanisms for fertility protection in chemotherapy-associated ovarian damage.

Increased cellular senescence in doxorubicin-induced murine ovarian injury: effect of senolytics

“…Chemotherapy-associated ovarian damage not only leads to amenorrhea, early menopause, and infertility in young female cancer patients but also promotes premature aging in cancer survivors and amplify the risk of age-related diseases such as Alzheimer's disease, cardiovascular disease, and osteoporosis [10,37,38]. Existing fertility preservation strategies, such as preventive agents, embryo and oocyte cryopreservation, ovarian tissue cryopreservation, stem cell therapy, and artificial ovary, may benefit women with cancer [15,16]. But these methods are still not widely used owing to their limited benefits, low success rate, risk of cancer recurrence, or ethical issues.…”

“…Protectants targeting these mechanisms have been developed using mouse models, but these agents had limited effects and have not been tested for their ability to protect against ovarian injury in humans [13,14]. General fertility preservation strategies, such as embryo and oocyte cryopreservation, provide confined benefits and have many limitations [15,16]. Therefore, new drugs and mechanisms of damage need to be explored.…”

The effects and mechanism of taxanes on chemotherapy-associated ovarian damage: A review of current evidence

“…GnRH analogs (GnRHa), comprising agonists and antagonists, produce a similar decline in GnRH secretion through different pathways (93). GnRHa inhibit the secretion of gonadotropins and prevent follicles development through the HPO axis, reducing chemotherapeutic drugs' damage to actively growing follicular cells (94). The underlying mechanism of ovarian protection may be the reduction of ovarian blood perfusion induced by GnRHa, thereby reducing chemotherapeutic drug accumulation (95).…”

Herbal Medicine: Promising Treatment for Chemotherapy-Induced Ovarian Dysfunction

“…Amenorrhea resulting from chemotherapy varies according to different factors such as the dose and type of chemotherapy used, the type of patient's disease and the age of the patient. Chemotherapeutic agents cause different consequences as 38% of women after treatment are less likely to get pregnant (Spears et al, 2019;Shin et al, 2021;Xiong et al, 2021).…”

“…Usually, CP decreases the glutathione (GSH) in ovaries leading to granulose cell apoptosis and it can destroy follicles. More than 50% of women treated with high doses of CP are more likely to have amenorrhea after the age of 30 years as CP causes oocyte, granulose cells damage and damage the ovarian medulla blood vessels by increasing immune inflammation response (Emadi et al, 2009;Gürgen et al, 2013;Avci et al, 2017;Xiong et al, 2021). CP not only affects women but also affects men and can cause azoospermia and oligospermia (Hassanpour et al, 2017).…”