Abstract
BACKGROUND: Reduced ovarian reserve is an important factor affecting female fertility, and exosomes from mesenchymal stem cell sources have shown great potential to enhance impaired ovarian reserve. However, there is a lack of comparisons and summaries of various sources of exosomes for treatment, and the optimal stem cell source is unknown. METHODS: Databases of PubMed, Web of Science, Embase, China Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and China Biomedical Literature Service System (SinoMed) from inception to March 1, 2025. Two independent reviewers performed the literature search, identification, screening, quality assessment and data extraction. RESULTS: In total, 33 relevant studies involving 6 interventions were included after screening. Notably, human adipose mesenchymal stem cells-derived exosomes (hADMSCs-Exo) (standardized mean difference [SMD] = 8.99, 95% confidence interval[CI] [4.54, 13.45]), amniotic fluid mesenchymal stem cells-derived exosomes (AFMSCs-Exo)(SMD = 8.49, 95% CI [5.40, 11.57]), human umbilical cord mesenchymal stem cells-derived exosomes (hUCMSCs-Exo) (SMD = 3.70, 95% CI [2.05, 5.35]), and bone marrow mesenchymal stem cells-derived exosomes (BMSCs-Exo) (SMD = 3.55, 95% CI [1.74, 5.37]) demonstrated significant improvements in anti-Mullerian hormone (AMH) levels compared to the control group. AFMSCs-Exo and hADMSCs-Exo were probably the most effective intervention according the surface under the cumulative ranking curve (SUCRA). CONCLUSIONS: Exosomes derived from stem cells can significantly improve ovarian reserve function, and exosomes derived from human adipose tissue mesenchymal stem cells and amniotic fluid mesenchymal stem cells have the most therapeutic potential and should be the focus of future attention, despite the current emphasis on exosomes from human umbilical cord mesenchymal stem cells, emphasizing the need for more high-quality studies to explore the therapeutic efficacy of exosomes and the best source of stem cells. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12015-026-11097-6.