Premature Ovarian Insufficiency: Emerging Role of Autologous Regenerative Therapies in Ovarian Function and Fertility Outcomes—A Narrative Review

Abstract

Premature ovarian insufficiency is defined by loss or marked impairment of ovarian function before the age of 40 years and is associated with menstrual disturbance, infertility, hypo-oestrogenism, and long-term health consequences. Affected women may experience vasomotor symptoms, urogenital symptoms, reduced bone mineral density, increased cardiovascular risk, and psychological distress. Conventional management mainly includes hormone therapy to reduce the effects of oestrogen deficiency and assisted reproductive options, particularly oocyte donation, for women seeking pregnancy. These approaches are clinically important but do not restore intrinsic ovarian activity. This review discusses the emerging role of autologous regenerative therapies in premature ovarian insufficiency, with emphasis on mesenchymal stem cell-based approaches and platelet-rich plasma. Available evidence suggests that these interventions may act through paracrine, angiogenic, anti-apoptotic, anti-inflammatory, and tissue-repair mechanisms within the ovarian microenvironment. Early clinical and preclinical studies have reported improvements in ovarian reserve markers, menstrual activity, ovarian response, and occasional pregnancies following intraovarian regenerative interventions. However, the available evidence remains limited by small sample sizes, heterogeneous protocols, short follow-up periods, reliance on surrogate outcomes, and limited data on live birth rates and long-term safety. Ovarian regenerative therapies remain investigational and should not be considered established alternatives for conventional management. Careful patient counselling, ethical oversight, standardised protocols, and transparent reporting are essential. Large randomised controlled trials with long-term follow-up are required to determine safety, efficacy, durability of response, appropriate patient selection, and clinically meaningful reproductive and endocrine outcomes before routine clinical implementation can be recommended.