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The therapeutic effects of MSCs are attributed to mechanisms such as <jats:italic>in vivo<\/jats:italic> and <jats:italic>in vitro<\/jats:italic> differentiation into germ cells, improved antioxidant capacity of testicular tissue, inhibited secretion of inflammatory factors and elevated anti-inflammatory level of testicular tissue, prevention of excessive apoptosis of testicular tissue cells, restoration of the normal secretion of sexual hormone levels <jats:italic>in vivo<\/jats:italic>, and regulation of sperm autophagy. Simultaneously, this study also emphasized on the latest progress in the research of MSC-Exos, with the discussion of its potential advantages over traditional MSC therapy. In addition, this review also elucidated challenges in the clinical translation of MSCs, including safety and standardization issues, as well as the necessity of conducting human clinical trials. 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