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The literature also describes upregulation of growth factors involved in tissue repair, modulation of nitric oxide synthase activity, and effects on the dopaminergic and serotonergic systems that are harder to interpret clinically [Sikiric et al., Inflammopharmacology, 2018]

Letourneau JM, Ebbel EE, Katz PP, Oktay KH, McCulloch CE, Ai WZ et al (2012) Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer

This is a legitimate concern that requires proactive management

Yes, but this adds a dilution step that introduces additional error potential