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Firstly, alterations in the hypothalamic-pituitary-ovarian axis lead to the secretion of gonadotropins and steroid hormones, with adverse effects on ovulation and implantation, leading to fertility decline

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Moreover, these molecular changes were accompanied by a phenotypic switch in macrophage polarization, favoring the anti-inflammatory M2 subset over the pro-inflammatory M1 phenotype (Liu et al., 2025)