Long-acting gonadotropin-releasing hormone agonist trigger in fertility preservation cycles before chemotherapy

Humanin alone and in combination with GnRHa therapy attenuates ovarian dysfunction induced by prepubertal cyclophosphamide chemotherapy in female mice

Prepubertal chemotherapy induced ovarian damage poses a significant threat to female fertility, particularly following cyclophosphamide (CP) treatment. Humanin (HNG), a small molecule polypeptide encoded by mitochondrial DNA, has a variety of effects, this study aimed to investigate the protective effects of HNG and its combination with conventional Gonadotropin Releasing Hormone Agonist (GnRHa) on ovarian function in a CP-induced damage model. The 21-day-old C57BL/6 J female mice were randomly assigned to six groups: Control, CP model, HNG, HNG+CP, GnRHa+CP, and HNG+GnRHa+CP. Reproductive related parameters were assessed through histopathological examination, follicle counts, serum sex hormone levels, estrous cycle monitoring, and oxidative stress evaluation. Results indicated that CP treatment led to significant reproductive dysfunction especially ovarian dysfunction, evidenced by reduced follicles, hormonal imbalances, prolonged estrous cycles, reduced body weight, and diminished ovarian and uterine weights, alongside pathological alterations. Notably, HNG treatment, both alone and in conjunction with GnRHa, significantly mitigated these adverse effects, however the combination did not provide additional benefits over HNG alone regarding follicles preservation and antioxidant capacity. Transcriptomic analysis revealed significant enrichment in inflammation and immune response pathways following HNG treatment. In conclusion, HNG demonstrates potential as a therapeutic agent to protect against CP-induced ovarian damage, offering insights for future strategies aimed at preserving female fertility during chemotherapy.

Future perspectives of fertility protection

Reproductive health is of major importance for individuals, for the society and for the health of future generations. This includes physical and medical dimensions as well as psychosocial and ethical ones. Whenever the possibility of starting a family is compromised, either due to an oncological cytotoxic treatment or due to transgender hormone medication with the aim to align their secondary sexual characteristics or other medical or social conditions, one key aspect of reproductive health is fertility protection. However, as a very young field in medicine, there are still many research questions that need to be clarified to provide the best possible treatment for affected people. These include the optimization and safety of cryopreservation processes of germ cells in women, men, transgender people, adolescents and children. Another focus is on psychological care as well as ethical, economic and legal issues. The establishment and development of the center for fertility protection Ulm (FePro-Ulm) will focus on a detailed molecular biological and (epi)genetic understanding of the underlying processes in ovarian tissue, oocytes and sperm to improve and develop new diagnostic and therapeutic approaches. The individual needs of affected people, their partners and families will be evaluated by an interdisciplinary approach. The collaborations within FePro-Ulm will develop preventative and helpful interventions for affected people. In addition, a better awareness of this important topic of reproductive health and fertility protection will be addressed by including participation representatives and strengthen public relation works.