akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2025.695akusherstvo-2632Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫCurrent approaches to restore fertility in women of advanced reproductive age with low ovarian reserve: a literature reviewСовременные подходы к восстановлению фертильности у женщин позднего репродуктивного возраста с низким овариальным резервом: обзор литературыhttps://orcid.org/0000-0003-4511-6085ШукуровФ. И.ShukurovF. I.

Шукуров Фархад Ишкулович - д.м.н., проф.

Узбекистан, 100109 Ташкент, ул. Фараби, д. 2

Farkhad I. Shukurov - MD, Dr Sci Med, Prof.

2 Farobi Str., Tashkent 100109, Uzbekistan

prof.farxadshukurov@gmail.comhttps://orcid.org/0000-0002-3845-5567АхмеджановаХ. З.AkhmedzhanovaKh. Z.

Ахмеджанова Хуршида Закировна - к.м.н.

Узбекистан, 100109 Ташкент, ул. Фараби, д. 2

Khurshida Z. Akhmedzhanova - MD, PhD.

2 Farobi Str., Tashkent 100109, Uzbekistan

xurshidazakirovna@mail.ruhttps://orcid.org/0000-0002-7749-4761МадолимоваН. Х.MadolimovaN. X.

Мадолимова Намуна Хасанбоевна - к.м.н.

Узбекистан, 100109 Ташкент, ул. Фараби, д. 2

Namuna M. Madolimova - MD, PhD.

2 Farobi Str., Tashkent 100109, Uzbekistan

namunakhan1992@gmail.comТашкентский государственный медицинский университетУзбекистанTashkent State Medical UniversityUzbekistan202612032026201204219Copyright © Shukurov F.I., Akhmedzhanova K.Z., Madolimova N.X., 20262026Шукуров Ф.И., Ахмеджанова Х.З., Мадолимова Н.Х.Shukurov F.I., Akhmedzhanova K.Z., Madolimova N.X.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2632Aim

Aim: to systematize current data on diagnostic potential and therapeutic approaches to restore fertility in women of advanced reproductive age with diminished ovarian reserve, as well as to identify promising directions for further research.

Materials and Methods

Materials and Methods. The review includes scientific publications indexed in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar spanning from January 2020 to January 2025 inclusive, according to the indexing status at the time of the literature search. Article selection was performed in accordance with the PRISMA international guidelines. At the initial search stage, 397 publications were identified in PubMed/MEDLINE, 96 in Scopus, 121 in Web of Science, and 28 in Google Scholar. Duplicate and non–full-text records were excluded. After the selection procedure, 60 publications were included in the final review, comprising randomized clinical trials, meta-analyses, systematic reviews.

Results

Results. Literature analysis demonstrated that the assessment of anti-Müllerian hormone levels and the antral follicle count remain the most reliable predictors of ovarian reserve and treatment outcomes. Individualized protocols for controlled ovarian stimulation improve the rate of mature oocyte retrieval; however, their efficacy is limited by age-related decline in oocyte quality. Experimental approaches such as platelet-rich plasma (PRP) therapy, stem cell application, and mitochondrial support show promising results in pilot studies but require further standardization and evaluation of long-term safety. The use of donor oocytes remains the most effective strategy in cases of severe ovarian reserve depletion.

Conclusion

Conclusion. Despite advances in elucidating the pathogenesis of ovarian aging, optimizing fertility restoration in women of advanced reproductive age with diminished ovarian reserve remains a multifactorial challenge. The most promising directions include the individualized selection of stimulation protocols, integration of supportive and experimental methods, as well as development of molecular and genetic biomarkers for personalized therapy.

Цель

Цель: систематизировать современные данные о диагностических возможностях и терапевтических подходах к восстановлению фертильности у женщин позднего репродуктивного возраста с низким овариальным резервом, а также определить перспективные направления для дальнейших научных исследований и клинической практики.

Материалы и методы

Материалы и методы. В обзор включены научные публикации, размещенные в базах данных PubMed/MEDLINE, Scopus, Web of Science, Google Scholar за период с января 2020 г. по январь 2025 г. включительно согласно состоянию индексации на момент проведения поиска. Отбор статей осуществлялся в соответствии с международными рекомендациями PRISMA. На первом этапе поиска было выявлено 397 публикации в PubMed/MEDLINE, 96 публикаций в Scopus, 121 публикация в Web of Science и 28 в Google Scholar. Дубликаты и неполнотекстовые версии были исключены. После процедуры отбора в обзор включены 60 публикаций, содержащих рандомизированные клинические исследования, метаанализы, систематические обзоры.

Результаты

Результаты. Определение уровня антимюллерова гормона и подсчет антральных фолликулов являются наиболее надежными предикторами овариального резерва и исходов лечения. Индивидуализированные протоколы контролируемой овариальной стимуляции позволяют увеличить частоту получения зрелых ооцитов, однако их эффективность ограничена возрастным снижением качества ооцитов. Экспериментальные подходы – терапия обогащенной тромбоцитами плазмой (англ. platelet-rich plasma, PRP), использование стволовых клеток, митохондриальная поддержка демонстрируют перспективные результаты в пилотных исследованиях, но требуют дальнейшей стандартизации и оценки долгосрочной безопасности. Применение донорских ооцитов остается наиболее результативной стратегией при выраженном снижении овариального резерва.

Заключение

Заключение. Несмотря на прогресс в изучении патогенеза овариального старения, оптимизация восстановления фертильности у женщин позднего репродуктивного возраста с низким овариальным резервом остается комплексной задачей. Наиболее перспективными направлениями являются индивидуализированный выбор протоколов стимуляции, интеграция поддерживающих и экспериментальных методов, а также развитие молекулярных и генетических биомаркеров для персонализации терапии.

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The authors declare that there are no conflicts of interest present.