Exosomes in assisted reproductive technologies: Discovery of new mechanisms and therapeutic possibilities

Exosomes are a type of extracellular vesicle, shed by almost all reproductive tissues, and critically mediate intercellular communication in both physiological and pathological aspects of human reproduction. Exosomes can transport biological cargo such as proteins, lipids, and many RNA species, and thus they regulate reproduction-related events, including gametogenesis, fertilization, embryo implantation, and development. This review will emphasize the mechanistic roles of exosomes in the context of female and male reproductive physiology, as well as embryo-endometrial communication and immune modulation in early pregnancy. In assisted reproductive technologies (ART), exosomes are being considered for their diagnostic and therapeutic capacity. They are currently being developed as non-invasive biomarkers of oocyte quality, embryo viability, and endometrial receptivity, and have also been used to enhance embryo culture condition, improve cryopreservation outcomes, and deliver targeted therapies. In addition, in regenerative medicine applications for fertility treatment, particularly in endometrial repair, and restoration of ovarian function, exosomes are being used as flexible agents. However, despite recent advances, several challenges hinder clinical implementation, including inconsistencies in research methodologies, unclear regulatory frameworks, and limited clinical translation. Future avenues of exosome research need to concentrate on standardizing exosome isolation methods, the engineering of exosome vesicles for targeted delivery, the and incorporation of omics technologies for individualizing reproductive care. Collectively, exosomes are a new frontier in ART innovation, providing another modality for increasing reproductive success through precision medicine.