Engineered extracellular vesicles in female reproductive and pregnancy-related disorders

Human reproduction involves a series of highly regulated biological processes, including oogenesis, fertilization, embryo implantation, and maternal-fetal interactions. Disruptions in these processes often result in reproductive disorders, including infertility, recurrent pregnancy loss, preeclampsia, and preterm birth. Currently available therapeutic strategies are often limited by potential harm to gametes, embryos, or fetuses and off-target effects. Engineered extracellular vesicles (EVs) have emerged as a promising approach due to their excellent biocompatibility, stability in circulation, prolonged circulation time, efficient cargo delivery, and potential for cell- or tissue-specific targeting. While still in the preclinical stage, engineered EVs are already reshaping basic research by enabling cell-specific modulation of reproductive and immune processes. By exploring engineering techniques, novel biomarkers, and new targeting approaches in animal models and clinical trials, we provide new insights into how engineered EVs could transform the treatment of female reproductive disorders. We also discuss ongoing challenges, including issues of manufacturing scalability, regulatory approval, and translating preclinical efficacy into clinical settings. With further collaboration between researchers, clinicians, and biotech innovators, engineered EVs could one day become a powerful tool to support women's reproductive health.