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Traditional approaches to evaluate female fertility rely primarily on hormonal measurements (anti-Mllerian hormone [AMH], follicle-stimulating hormone [FSH], luteinizing hormone [LH]), ultrasound-based assessments (antral follicle count [AFC], endometrial thickness), and limited molecular functional assays (e.g., endometrial receptivity array [ERA]-based receptivity testing) [2, 5]

In cases of extreme stress and depression, HPA-D has been shown to be correlated with a decrease in brain derived neurotrophic factor 22 (BDNF)