The Fibro-Inflammatory Ovary: Stromal Fibrosis, Extracellular Matrix Remodeling, and Mechanotransduction in Female Infertility.

Endocrine disorders and inherent flaws in oocyte quality are traditional causes of female infertility. Increasing research indicates that structural and biomechanical alterations in the ovarian microenvironment may significantly contribute to reproductive decline. Progressive extracellular matrix remodeling, stromal fibrosis, chronic inflammation, and heightened tissue stiffness seem to affect follicular homeostasis, granulosa-oocyte communication, and ovarian function. Fibro-inflammatory pathways, including transforming growth factor-β (TGF-β), Hippo/YAP-TAZ signaling, oxidative stress, macrophage activation, and mechanotransduction, are increasingly associated with ovarian ageing, polycystic ovary syndrome, reduced ovarian reserve, and unfavourable reproductive outcomes. Here, the term 'fibro-inflammatory ovary' is used descriptively to unify these mechanisms rather than as an established clinical entity. Mechanical alterations of the ovarian stroma may affect follicular activation, vascularization, and oocyte competence by altering cellular tension and extracellular matrix dynamics. Our review examines growing findings about ovarian fibrosis and stromal remodeling in female infertility, focusing on molecular causes, mechanobiology, and translational implications for assisted reproduction. Potential diagnostic uses, such as ovarian elastography, and prospective anti-fibrotic therapy techniques are also examined.