Evidence-based interventions to restore or improve female fertility in women aged 30-42 years: a systematic review by etiology and evidence level
Abstract
IMPORTANCE: Female infertility affects approximately one in six couples worldwide and disproportionately impacts women aged 30-42 years, yet evidence on which interventions improve clinically meaningful outcomes (live birth and safety) is heterogeneous.
OBJECTIVE: The aim of this study was to synthesize evidence on interventions that restore or improve fertility in women aged 30-42 years, grouped by etiology.
EVIDENCE REVIEW: We conducted a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-compliant systematic review (PROSPERO CRD420251109428). PubMed and Scopus were searched for English/Spanish studies (1 January 2020 to 31 July 2025). Eligible designs were randomized trials and non-randomized interventional and observational studies. We aligned outcomes to the infertility core outcome set, prioritizing live birth per woman, then ongoing/clinical pregnancy and prespecified safety endpoints. Risk of bias used RoB 2 [randomized controlled trials (RCTs)], ROBINS-I (non-randomized), and JBI (observational). When pooling was not feasible, we applied SwiM (Synthesis Without Meta-analysis) and summarized by etiology and intervention class.
FINDINGS: A total of 21 studies met inclusion criteria for synthesis, and two additional randomized protocols were summarized narratively (23 records tracked overall). Interventions spanned hormonal therapies, assisted reproductive technologies (ART) strategies, surgical procedures, lifestyle and psychosocial programs,…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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