Onco-fertility and personalized testing for potential for loss of ovarian reserve in patients undergoing chemotherapy: proposed next steps for development of genetic testing to predict changes in ovarian reserve

摘要

Two mechanisms of chemotherapy-induced ovarian reserve depletion: increased apoptosis and accelerated follicle activation. A. DNA lesions induced by chemotherapy activates repair pathways. Failure to repair the lesions induces TAp63-mediated apoptosis of germ cells. B. Chemotherapy destroys growing follicles leading to a reduction in AMH level. This results in upregulation of PI3K/PTEN/AkT pathway which over-recruits primordial follicles. The accelerated activation of follicles ultimately leads to depletion of ovarian reserve [2]