Overview of the evaluation of the destructive effect of procarbazine on the ovarian reserve in the apoptotic, inflammatory, and oxidative pathways

The use of chemotherapeutic agents during childhood, adolescence, and early adulthood has a detrimental effect on ovarian functions, leading to a decrease in ovarian reserves, thus adversely affecting fertility. Alkylating agents are one of the most frequently used groups of chemotherapeutics in this age group. An important and effective chemotherapeutic drug, procarbazine is used to treat brain tumors and Hodgkin lymphoma in children, adolescents, and young adults. This agent is also an indispensable component of combination-type chemotherapy. Procarbazine has a detrimental impact on ovarian reserve by directly targeting the oocyte or indirectly through somatic cell destruction. Evidence gathered thus far indicates that procarbazine's mode of action in the ovaries may involve apoptosis, inflammation, and oxidative stress. This review seeks to clarify the processes by which procarbazine might induce apoptosis, inflammation, and oxidative stress, hence affecting ovarian reserve and functioning.