Current approaches to restore fertility in women of advanced reproductive age with low ovarian reserve: a literature review

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. 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. 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. 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.

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