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N Engl J Med 348:20072018 Kadiri JJ, Tadayon S, Thapa K, Suominen A, Hollmn M, Rinne P (2021) Melanocortin 1 receptor deficiency in hematopoietic cells promotes the expansion of inflammatory leukocytes in atherosclerotic mice

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In some cases, additional investigations such as hormonal profiling, genetic testing, or imaging studies may be necessary to identify underlying conditions or abnormalities that affect fertility