Abstract
Female infertility affects approximately 10–15% of women of reproductive age
worldwide and represents a major global health concern. Classical biomarkers such
as anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and antral
follicle count (AFC) remain central to infertility assessment; however, they have lim
ited ability to predict oocyte competence, embryo quality, and implantation potential.
Advances in molecular biology and omics technologies have expanded the range of
biomarkers available for evaluating female reproductive function. This narrative re
view synthesizes current evidence on emerging biomarkers of female infertility, in
cluding molecular markers (microRNAs, cell-free DNA, exosomes, and extracellular
vesicles), oxidative stress markers, inflammatory cytokines, metabolomic signatures,
oocyte-derived growth factors, endometrial receptivity markers, microbiota profiles,
and environmental exposure biomarkers. These biomarkers are discussed in relation
to their biological relevance and potential clinical utility, with critical appraisal of
evidence linking them to ovarian reserve, oocyte and embryo quality, implantation,
and pregnancy outcomes. Their applicability to specific infertility phenotypes, such
as polycystic ovary syndrome, endometriosis, recurrent implantation failure, and un
explained infertility, is also highlighted. Overall, emerging biomarkers show promise
for improving diagnostic accuracy, prognostic evaluation, and personalized treatment
strategies. Nevertheless, significant challenges remain, including assay standardiza
tion, limited validation in large and diverse populations, and uncertain clinical feasi
bility. Therefore, integrated biomarker panels, rather than single markers, are most
likely to advance precision diagnostics and clinical decision-making in female infer
tility.
