Fig. 1.

Mechanism of primordial follicle (PF) loss by chemotherapeutics and ovotoxicity along with proposed fertoprotective agents to maintain the ovarian reserve. PFs consist of oocytes and squamous pregranulosa cells, while growing follicles are surrounded by cuboidal granulosa cells in the ovary. Fertoprotective agents have been proposed against the cytotoxic consequences of chemotherapeutic agents or ovotoxicity on PFs.

G-CSF, granulocyte-colony stimulating factor; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone; ATM, ataxia-telangiectasia mutated; ATR, ataxia telangiectasia and Rad3-related; CHEK2, checkpoint kinase 2; CK1, casein kinase 1; S1P, sphingosine-1-phosphate; C1P, ceramide-1-phosphate; AMH, anti-Müllerian hormone.