Developments in pharmacotherapy for the preservation of ovarian function during cancer treatment

Introduction: Cancer is one of the major causes of human death, and anti-cancer therapy often results in premature ovarian failure and infertility, depending on factors such as age, initial ovarian reserve, and chemotherapy type and dose. Fertility preservation procedures, such as oocyte, embryo, and ovarian cortex cryopreservation, can help women achieve pregnancy after cancer treatment. However, the development of pharmacological therapies to protect ovarian function during chemotherapy would represent a significant advancement. Areas covered: We searched the published articles in PubMed up to December 2024, containing key words '"chemotherapy",' 'cancer,' '"ovarian protection",' '"pharmacological therapy",' '"ovarian reserve"' and '"fertility".' Chemotherapeutic agents act via various mechanisms in the human ovary, including direct DNA damage leading to oocyte apoptosis, as well as damage to ovarian stroma and microvascular architecture. In recent years, numerous protective agents have emerged, showing promise in protecting ovaries from chemotherapy-induced damage. However, most studies have relied on animal models, and only a limited number have directly tested these agents in human ovarian tissue. At present, no pharmacological treatment has been conclusively proven effective for preserving fertility. Expert opinion: A comprehensive understanding of the mechanisms underlying chemotherapy-induced ovarian damage is critical for the development of efficient and targeted pharmacological therapies.