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Chronic hyperglycemia, a hallmark of diabetes, significantly alters sperm metabolic pathways, particularly glycolysis and oxidative phosphorylation, leading to energy insufficiency and impaired sperm motility [217, 218]

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29 cohorts, 2,358 participants) - a primary marker of autoimmune activity in Hashimoto's *Significant reduction in TSH levels in patients not on thyroid hormone replacement (SMD 0.21

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