Viral Infections and Ovarian Reserve: Mechanistic Insights into Ovarian Aging- A Review.
Haratian Kaveh K, Borjian Boroujeni Parnaz P, Zarei Moradi Shabnam S, Mohseni Meybodi Anahita A
Ovarian aging, marked by the progressive loss of follicular reserve and decline in oocyte quality, is a principal determinant of female reproductive lifespan. While genetic and environmental factors are well-established contributors, viral infections, including both DNA and RNA viruses, are increasingly recognized as significant extrinsic modulators of ovarian function. This review synthesizes current evidence on the mechanisms and clinical outcomes by which key viral pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hepatitis B virus (HBV), human immunodeficiency virus (HIV), cytomegalovirus (CMV), human papillomavirus (HPV), mumps virus, herpes simplex virus (HSV), and rubella virus, affect ovarian aging and reserve. The discussion highlights those viral infections can impact ovarian function through inflammation, cytopathic effects, oxidative stress, and immune-mediated mechanisms, although the magnitude and clinical relevance vary. Current evidence for viruses such as SARS-CoV-2 and HBV is limited and inconsistent, highlighting the need for individualized assessment when considering fertility interventions. Further longitudinal and mechanistic studies are essential to clarify long-term reproductive outcomes and to guide evidence-based fertility counseling.