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most effects persist at 1 year, including a significant reduction in shunt placement (OR 0.375)

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Epigenetic mechanisms further exacerbate this: hypoxia, a key pathological process in endometriosis, upregulates histone methyltransferase EZH2, which catalyzes H3K27Me3 modification at the IGFBP1 promoter, suppressing this critical decidual marker and directly impairing decidualization (49)

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