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262 Infertility is a serious cause of psychological and emotional distress, often prompting reactions such as shock, a sense of losing control, low self-esteem, anger, frustration, sadness, and grief, and the emotional toll increases the longer infertility persists

1 Even with enzyme activity that is substantially reduced, there may be few or no clinical symptoms

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The authors commented that this may be due to rectal cancer presenting at an earlier stage than colon cancer, which may have masked the association with IGF1 levels 70