Is the ovary protected by being suppressed before antineoplastic therapy?
The concept of using hormonal therapy to suppress ovarian function before and during treatment with an antineoplastic agent, to reduce gonadotoxic effects, is based on the observation that noncycling cells are generally more resistant to cell death from antineoplastics than rapidly proliferating cells. Gonadotropin suppression can be achieved with oral contraceptives (OCs) or GnRH analogs. Gonadotropins act primarily on the cyclic recruitment of antral follicles and not on initial recruitment of primordial follicles, however—and it is the larger pool of primordial follicles that one is primarily trying to protect.5 Unlike antral follicles, primordial follicles do not contain FSH receptors and neither type of follicle has been found to contain GnRH receptors.48 Nevertheless, suppressive treatment has demonstrated protective effects in ovarian follicles in rats49 (although results did not show that primordial follicles were protected50). Furthermore, studies using a GnRH agonist50 or ant
