Evaluating the Role of Exosome Therapy in Reproductive Aging:A Narrative Review of Recent Advancements.

INTRODUCTION: Exosome therapy shows promise as a non-hormonal treatment to restore ovarian function and combat reproductive aging. This review aims to explore recent advances, mechanisms, and clinical potential of exosome therapy in reproductive aging. METHODS: This narrative review explored advancements in exosome therapy for reproductive aging through a comprehensive literature search of PubMed, Embase, Google Scholar, and ClinicalKey, covering studies from 2015 to 2025. Using a structured search strategy with relevant MeSH terms and keywords. After applying inclusion and exclusion criteria focused on human studies with therapeutic relevance, 13 articles were selected. Key data were extracted and synthesized to highlight mechanisms, clinical potential, and future directions of exosome-based interventions in ovarian aging. RESULTS: Thirteen human-focused studies were categorized into four themes: ovarian function restoration, exosomal biomarkers, therapeutic roles in reproductive diseases, and clinical applications. Exosomes especially MSC-derived enhanced ovarian regeneration through anti-apoptotic, anti-inflammatory, and metabolic pathways. Age-related changes in exosomal cargo showed strong diagnostic potential. Exosomes also demonstrated therapeutic effects in POI and PCOS and showed promise as low-immunogenic, cell-free nanocarriers for targeted reproductive-aging interventions. CONCLUSION: Exosome therapy is a promising, non-hormonal option for addressing reproductive aging, with potential for safe and effective clinical use.