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The shedding looks alarming but represents follicles catching up on delayed transitions, once the metabolic stress stabilizes, your follicles re-enter the growth phase

DePietro says

The medication's Summary of Product Characteristics (SmPC) does not list male infertility or reduced sperm quality as recognised adverse effects

In the normal individual (type I) the crural diaphragm effect is directly superimposed on the LES resulting in substantial pressure augmentation during respiration, the extremes of which are illustrated in the spatial pressure variation plots in the lower panels
