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Pelkonen, University of Oulu, Finland Reviewed by Risto Juvonen, University of Eastern Finland, Finland

In particular, metabolic disorders including diabetes, obesity, and hyperlipidemia commonly associated to hypercaloric diets are suspected to affect a woman's fertility either by direct damage to oocyte health and differentiation, or by indirect interference with the pituitary-hypothalamic axis, resulting in dysfunctional oogenesis

The practical implication is to evaluate medication, sleep, nutrition, metabolic health, substance exposure, inflammation, copper-zinc balance, manganese, antioxidant reserve, methylation and overall function rather than reducing the case to one diagnosis

Worse, from a historical perspective it is deteriorating at an alarming rate