Co-authored by Dr. Rutuja, Parency IVF
Ovarian ageing is a natural process that affects fertility and endocrine health in women. Recent advances in mitochondrial medicine are opening exciting possibilities for delaying or mitigating age-related declines in ovarian function. By focusing on the energy-producing mitochondria within ovarian cells, clinicians can now explore interventions that support oocyte quality, hormone balance, and reproductive longevity.
Mitochondria, often referred to as the “powerhouses” of cells, play a critical role in energy production, cellular signalling, and overall cell health. As women age, mitochondrial function in ovarian tissue tends to decline. This manifests as reduced ATP production, increased oxidative stress, and decreased oocyte quality. Over time, these changes contribute to diminished ovarian reserve and fertility challenges.
Therapeutic strategies that restore or enhance mitochondrial function aim to:
1. Antioxidants and Nutraceuticals
Targeted antioxidants such as Coenzyme Q10, N-acetylcysteine (NAC), resveratrol, and α-lipoic acid have shown promise in reducing oxidative stress and improving cellular energy in ageing ovaries. Additionally, NAD+ precursors and other mitochondrial cofactors may support energy metabolism and mitochondrial turnover.
2. Lifestyle Interventions
Healthy habits like regular physical activity, intermittent fasting, and balanced nutrition can stimulate mitochondrial biogenesis and promote cellular rejuvenation. These non-invasive strategies complement clinical interventions and support long-term ovarian health.
3. Mitochondrial Replacement Therapies (MRT)
Emerging procedures such as autologous mitochondrial transplantation, cytoplasmic transfer, and germline nuclear transfer aim to introduce healthy mitochondria into oocytes. While still investigational, these approaches hold potential for improving egg quality in women with age-related mitochondrial decline.
4. Hormonal and Metabolic Modulation
Hormone therapies, particularly estrogen, may partially restore mitochondrial function and promote bioenergetics in ovarian tissue. Additionally, compounds targeting metabolic pathways and sirtuin signalling may further enhance mitochondrial resilience.
5. Regenerative and Cellular Therapies
Early research suggests that stem cell-derived exosomes or cellular therapies can deliver functional mitochondria and rejuvenating factors to ovarian cells. While primarily experimental, these strategies indicate a growing intersection between regenerative medicine and reproductive health.
Blood and follicular fluid analyses for mitochondrial markers, such as mtDNA and NSUN4, are being explored as predictors of ovarian reserve and therapy responsiveness. Integration of these biomarkers with clinical protocols could enable personalised fertility interventions in the near future.
Mitochondrial medicine represents a paradigm shift, moving beyond conventional hormone therapy to targeted cellular rejuvenation. Personalised strategies, guided by mitochondrial biomarkers and ovarian reserve assessments like AMH and AFC, can optimise outcomes and reduce risks.
Recent research also challenges traditional assumptions about reproductive ageing. A 2025 study published in the European Medical Journal found that while egg quantity declines with age, DNA quality remains stable, unlike sperm, which accumulates mutations over time. This underscores the importance of considering both partners’ ages in fertility planning.
Mitochondrial medicine is a groundbreaking approach that holds the potential to transform fertility care, especially for women experiencing ovarian ageing. By targeting mitochondrial function, we can enhance egg quality, support ovarian reserve, and extend reproductive longevity. As research progresses, these therapies could become crucial tools in combating age-related fertility challenges.
