Finerenone shows promise for restoring fertility in premature ovarian insufficiency

In patients with premature ovarian insufficiency (POI), finerenone, a drug approved for slowing progressive kidney function decline associated with type 2 diabetes, can promote the development of follicles into mature oocytes yielding viable embryos, according to breakthrough findings by researchers from the University of Hong Kong (HKU).

“In the past, treatments for POI-related infertility focused mainly on directly stimulating the follicles, but the overall efficacy was limited. Our study is the first to show that improving the ovarian microenvironment, especially by addressing fibrosis, is key to restoring fertility,” said Professor Kui Liu, leader of the research team, from the Department of Obstetrics and Gynaecology, HKU.

Using the ‘drug repurposing’ strategy and with previous knowledge obtained from in-depth research on the regulatory mechanism of ovarian follicle development, the team systematically screened a US FDA–approved drug library of >1,000 agents and identified finerenone, a nonsteroidal antifibrotic drug with a favourable safety profile, as a promising drug for restoring fertility in POI. [Science 2026;391:eadz4075]

“Fibrosis, characterized by excessive deposition of collagen in the ovarian microenvironment, severely limits follicle growth and ultimately leads to infertility in patients with POI,” explained Professor Ernest Hung-Yu Ng, a member of the research team also from the Department of Obstetrics and Gynaecology, HKU. “We found that finerenone effectively reduces fibrosis, creating a favourable microenvironment facilitating activation and development of small dormant follicles into mature antral follicles.”

Drug repurposing leverages existing drugs with established safety profiles to accelerate clinical translation for new indications. “Thus, the lengthy and costly process involved in developing new drugs from scratch can be avoided,” noted Liu.

To evaluate the clinical potential of finerenone in treating POI-associated fertility, the team conducted an exploratory trial at HKU-Shenzhen Hospital in 2024. The pilot study included 14 women of childbearing age diagnosed with POI. All received pulsed oral finerenone therapy and 13 received mild ovarian stimulation. [Science 2026;391:eadz4075]

During the follow-up period of 3–7 months, follicular development waves were observed in all the patients, and a total of 80 antral follicle–like structures were observed in 72 ultrasound monitoring sessions. Eight of the 13 patients who received mild ovarian stimulation had 20 follicles that reached preovulatory size, of which three follicles underwent spontaneous ovulation. A total of 17 oocyte retrievals were performed, with an oocyte retrieval rate of 70.59 percent – comparable to conventional oocyte retrieval rates of 60–80 percent in women without POI.

Mature/metaphase II (MII) oocytes were obtained in seven of the participants. Four married participants with MII oocytes immediately received in vitro fertilization (IVF) treatment, and three of them each obtained one cleavage embryo. The three unmarried participants opted for cryopreservation of their MII oocytes. “The treatment results are highly encouraging,” said Dr Tianren Wang, another member of the team from the same department.