Beyond the clock: reprogramming fertility in diminished ovarian reserve.

In brief: Diminished ovarian reserve (DOR), a hallmark of female reproductive aging, impairs fertility and quality of life. Aging-reprogramming technologies offer new mechanistic and therapeutic insights. This review examines aging reprogramming in DOR-covering telomere shortening, mitochondrial dysfunction, and epigenetic alterations-alongside diagnostic criteria, biomarkers, and limitations of current treatments, highlighting emerging reprogramming-based interventions to improve reproductive health. Abstract: Diminished ovarian reserve (DOR) is a significant manifestation of female reproductive aging that profoundly impacts fertility and quality of life. In recent years, the emergence of aging-reprogramming technologies has provided new insights into the mechanisms underlying DOR and potential therapeutic approaches. This review synthesizes current knowledge on the role of aging reprogramming in DOR, focusing on key molecular events such as telomere shortening, mitochondrial dysfunction, and epigenetic alterations. Furthermore, we summarize clinical diagnostic criteria and emerging biomarkers for DOR, while exploring the limitations of existing treatment strategies and the potential interventions based on aging reprogramming. By addressing these issues, this review aims to highlight the interplay between aging processes and ovarian function, paving the way for innovative therapeutic avenues to improve reproductive health in women experiencing DOR.