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4.4 Challenges and future directions Although significant progress has been made, key challenges remain, including genetic heterogeneity such as MTHFR variants complicating folate dosing, limited clinical validation of oxidative stress biomarkers for infertility, and reliance on animal models, highlighting the need for human RCTs with stratified cohorts (Vitagliano et al., 2021

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The liver generates glutathione in reduced amounts