Chemotherapy and decline of the ovarian reserve: how can we explain it and how to prevent it?
VOLUME 114, ISSUE 4, P722-724
Jacques Donnez, MD, PhD
Understanding how chemotherapy affects gonadal function also allows us to understand the mechanisms protecting the pool of primordial follicles (namely, the ovarian reserve), and provides valuable insights into gonadoprotective agents that can be used to counter the adverse effects of toxic drugs. The effects of chemotherapeutic drugs on female reproduction began to be reported in the 1970s. The first accounts associated one particular alkylating agent, cyclophosphamide (CPM), with amenorrhea, premature ovarian insufficiency (POI), and ovarian dysfunction. Alkylating agents are derived originally from mustard gas chemical warfare agents. Cyclophosphamide is a prodrug and its primary active metabolite is phosphoramide mustard, inducing DNA crosslinking and finally preventing DNA replication (1).