Exosomes in oncofertility: emerging roles in chemotherapy-induced reproductive damage and fertility preservation

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Abstract Oncofertility has emerged as a critical interdisciplinary field addressing the reproductive challenges faced by cancer patients, particularly those undergoing chemotherapy. While chemotherapeutic agents remain indispensable in cancer therapy, their gonadotoxic effects frequently result in diminished ovarian reserve, impaired spermatogenesis, and long-term infertility. Exosomes - small extracellular vesicles enriched with nucleic acids, proteins, and lipids - are increasingly recognized as key mediators of intercellular communication in both pathological and regenerative contexts. Recent evidence suggests that chemotherapy alters exosome cargo, thereby amplifying cellular stress responses, oxidative damage, and bystander effects in gonadal tissues. Conversely, exosomes derived from mesenchymal stem cells, induced pluripotent stem cells (iPSCs), and other regenerative sources demonstrate the ability to restore ovarian and testicular function by reducing apoptosis, enhancing angiogenesis, and supporting germ cell survival. This dual role positions exosomes as both contributors to reproductive toxicity and promising therapeutic agents in fertility preservation strategies. However, clinical translation remains hindered by challenges including source heterogeneity, isolation methods, safety concerns, and regulatory barriers. This review highlights the emerging roles of exoso

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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