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Women with POI exhibit lower mtDNA copy numbers, frequent mitochondrial gene mutations, and defective oxidative phosphorylation ( in vitro follicle activation, stem cell and exosome therapies, biomaterial-based strategies, and intra-ovarian platelet-rich plasma infusion—holds promise for re-establishing oxidative balance and preserving ovarian function ( 4.3 Iatrogenic toxicity: ROS-induced granulosa cell death and follicle attrition Iatrogenic ovarian injury, particularly following chemotherapy with alkylating agents (e.g., cyclophosphamide, cisplatin) or anthracyclines (e.g., doxorubicin), represents an extreme form of acute oxidative insult

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It is thus expected that use of oxygenation agents together with A2ARi may enable more effective ACT when combined with lipid peroxidation inhibition