The nascent field of oncofertility is quickly gaining traction as novel experimental treatments are being developed, driving a renewed interest in Müllerian inhibiting substance (MIS) as an ovarian fertoprotectant.
MIS is unique in its mechanisms of ovarian protection by virtue of acting directly on granulosa cells of primordial follicles and for being a benign reproductive hormone, with few side effects. We will explore in this review how it may be utilized to protect the ovary from chemotherapy, or to enhance ovarian tissue cryopreservation therapy. We will also examine potential mechanisms of action of MIS across multiple cell types, as well as current limitations in our understanding of the pharmacology of recombinant MIS.
The usefulness of MIS as a fertoprotectant may be dependent on the mechanisms of gonadotoxicity of each chemotherapeutic. Further investigation is needed to determine how to best deliver and combine MIS treatment to existing fertility management strategies.
aPediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston
bDepartment of Surgery, Harvard Medical School, Cambridge
cDepartment of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
Correspondence to David Pépin, PhD, Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Simches Research Center, CPZN-6220, 185 Cambridge Street, Boston, MA 02114, USA. Tel: +1 617 838 3810; e-mail: firstname.lastname@example.org