Oxidative Stress in Female Reproductive Health and Infertility: Mechanisms, Biomarkers, Therapeutic Interventions

Abstract Female infertility is a significant global health problem affecting millions of women of reproductive age. Increasing evidence suggests that oxidative stress (OS) plays an important role in the pathophysiology of female infertility and reproductive disorders. Oxidative stress results from an imbalance between the production of reactive oxygen species (ROS) and the body's antioxidant defence systems. While physiological levels of ROS are essential for normal reproductive processes, including folliculogenesis, excessive ROS production can induce lipid peroxidation, protein oxidation, and DNA damage. Elevated oxidative stress has been associated with impaired oocyte quality, disrupted endocrine signalling, reduced endometrial receptivity, and adverse reproductive outcomes. Lifestyle, dietary, environmental, and genetic factors may influence oxidative balance and contribute to oxidative stress. Furthermore, increased oxidative stress has been linked to reproductive disorders such as polycystic ovary syndrome, endometriosis, and unexplained infertility. Biomarkers, including malondialdehyde, superoxide dismutase, total antioxidant capacity, and glutathione peroxidase, are commonly used to assess redox status. Dietary modifications and herbal medicinal plants have demonstrated potential in modulating oxidative stress and improving reproductive health in preclinical and limited clinical studies; however, their mechanisms of action and underlying biochemical pathways remain incompletely understood. Although growing evidence supports the involvement of oxidative stress in female reproductive dysfunction, further research is required to clarify its role in female reproduction and to evaluate the efficacy and safety of potential antioxidant-based interventions. Lay Summary Infertility is defined by the World Health Organization as the inability to achieve pregnancy after one year of regular, unprotected sexual intercourse. Female infertility can result from problems with ovulation, hormone imbalances, endometriosis, blocked fallopian tubes, and poor egg quality. One factor linked to these conditions is oxidative stress, which occurs when harmful molecules in the body exceed its natural antioxidant defences. This imbalance may damage reproductive cells and tissues, affecting hormone function, embryo quality, implantation, and pregnancy outcomes. Oxidative stress has been associated with several reproductive disorders, including polyendocrine metabolic ovarian syndrome (PMOS), previously called polycystic ovary syndrome, and endometriosis. As a result, there is growing interest in natural approaches that may help protect reproductive health. Some medicinal plants contain natural antioxidants that may reduce oxidative stress and protect reproductive cells from damage. This review examines the impact of oxidative stress on female reproductive health and explores the potential role of medicinal plants in supporting fertility and reproductive well-being.