The Impact of Oxidative Stress Imbalance on Ovarian Function and Its Mechanisms

Oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays a critical role in female reproductive health, particularly in ovarian function. This review provides a comprehensive and updated synthesis of the impact of oxidative stress on ovarian physiological processes, including follicular development, oocyte quality, steroid hormone synthesis, luteal function, and ovarian aging. We delve into the underlying molecular mechanisms-mitochondrial dysfunction, endoplasmic reticulum stress, inflammatory signaling (NF-κB, NLRP3), and epigenetic alterations-and discuss how these pathways converge to drive specific cell death modalities (apoptosis, pyroptosis, ferroptosis) in granulosa cells and oocytes. The review consolidates current knowledge on diagnostic biomarkers, associated pathological conditions (polycystic ovary syndrome, premature ovarian insufficiency, endometriosis), and emerging intervention strategies. What distinguishes this review from existing literature is its systematic integration of mechanistic pathways with clinical phenotypes, its explicit discussion of conflicting evidence and knowledge gaps, and its forward-looking perspective on targeted therapies (mitochondria‑directed antioxidants, stem cell‑derived exosomes, traditional Chinese medicine) and lifestyle interventions. Our aim is to provide a theoretical foundation for understanding oxidative stress‑mediated ovarian dysfunction and to offer practical insights for future research and clinical management.