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However, there is still a lack of sufficient prospective cohort or intervention studies to address the directional question of whether “iron overload/ferroptosis is a causal driving factor or key mediator of infertility.” Therefore, a more evidence-based statement should be: iron overload and ferroptosis provide a highly interpretable mechanistic framework for EMS-related reproductive damage, but “ferroptosis → infertility” remains in the evidence accumulation stage at the population level

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Eur J Gastroenterol Hepatol 1999