Female reproductive capacity preservation: antioxidant strategies in combating ovarian aging and cryopreservation challenges

The preservation of female fertility represents a pivotal area of focus within reproductive medicine, particularly in addressing ovarian damage resulting from oncological treatments and the decline in fertility associated with aging. Since the inaugural successful cryopreservation of a human oocyte in 1986, technological advancements have provided women with a form of "fertility insurance." Nevertheless, oxidative stress exerts a profound influence on oocyte quality and the outcomes of cryopreservation. An overproduction of ROS leads to mitochondrial dysfunction, DNA damage, and chromosomal aneuploidy, especially in women of advanced reproductive age, thereby diminishing oocyte quality. Oxidative stress interferes with spindle assembly, chromosome cohesion, and spindle assembly checkpoints, thereby elevating aneuploidy rates. During the cryo-preservation process, oxidative stress prompts apoptosis and follicular loss in both oocytes and ovarian tissue, thereby undermining the success of fertility preservation efforts. Anti-oxidants such as coenzyme Q10, melatonin, and nicotinamide have been shown to mitigate oxidative stress, enhance mitochondrial function, reduce apoptosis, and im-prove the quality of oocytes and the success rates of ovarian tissue cryopreservation. This review critically examines the effects of oxidative stress on oocyte development and cryopreservation, and investigates the potential of antioxidant interventions.