Emerging evidence suggests that chemotherapy may significantly impair ovarian function and fertility in women, with potential implications for reproductive health counselling and fertility preservation planning, according to a recent study reported this week.
Chemotherapy’s impact on ovarian function
Chemotherapy drugs are critical in cancer treatment but are known to exert toxic effects beyond tumour cells. The new research by examined how gonadotoxic chemotherapy regimens affect ovarian tissue, hormone production, and the pool of eggs a woman has available, collectively known as ovarian reserve, which is key to fertility potential.
The authors highlighted that certain chemotherapeutic agents can induce oxidative stress and programmed cell death in ovarian follicles. These processes can reduce ovarian volume, destroy growing and dormant follicles, and accelerate depletion of the egg reserve, potentially leading to diminished fertility or premature ovarian insufficiency.
Mechanisms of damage and clinical significance
The study outlined several mechanisms through which chemotherapy exerts its adverse effects on ovarian health. These include oxidative damage mediated by reactive oxygen species (ROS) and apoptosis (programmed cell death) within ovarian follicles. Damage to the ovarian microenvironment can compromise hormone production and disrupt the delicate balance required for follicle maturation and ovulation.
Such findings reinforce concerns that many common cancer treatments, while lifesaving, have a profound effect on reproductive organs. Women of reproductive age receiving chemotherapy may therefore face a reduced ovarian reserve, impaired fertility, and earlier menopausal onset compared with their untreated counterparts.
Implications for women’s reproductive care
These results underscore the importance of integrating fertility risk assessment and preservation strategies into cancer care for women. Healthcare providers are encouraged to discuss potential impacts on fertility before initiating gonadotoxic chemotherapy and consider referrals to fertility specialists when appropriate.
In pursuit of fertility preservation, options such as oocyte or embryo cryopreservation, ovarian tissue storage, or the administration of ovarian suppression therapies could be explored, depending on individual clinical circumstances. Long-term follow-up studies are needed to quantify the extent of reproductive impairment and to identify which chemotherapy regimens carry the highest risks.
Future research directions
The authors called for additional research into protective strategies that could minimise ovarian damage during cancer treatment, as well as studies that track fertility and reproductive outcomes in survivors over the long term. Disentangling the effects of different chemotherapeutic classes will be critical to personalised oncofertility care.
Reference
Zhou J et al. Fertility under fire: how chemotherapy harms the ovaries and the science fighting back?. J Ovarian Res. 2026;DOI:10.1186/s13048-025-01950-6.
