ROS: their roles in diminished ovarian reserve

Diminished Ovarian Reserve (DOR) is a core pathological condition leading to reduced female fertility, characterized by decreased follicular quantity and diminished oocyte quality in the ovaries, which significantly impacts natural pregnancy and assisted reproductive technology outcomes. Despite its complex etiology, recent studies have demonstrated that reactive oxygen species (ROS)-mediated oxidative stress (OS) serves as a common pathological hub, integrating multiple pathogenic factors, including aging, metabolic abnormalities, environmental exposure, and iatrogenic damage, throughout the process of DOR development. This article systematically reviews the key mechanisms of ROS in DOR and the corresponding intervention strategies. At the level of pathological mechanisms, ROS drive ovarian reserve depletion through a multilevel, networked mechanism. Based on mechanistic understanding, intervention strategies focus on mitochondrial-targeted antioxidants. This article provides a systematic framework for an in-depth understanding of the central role of ROS in DOR and the development of mechanism-driven intervention strategies.