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Reduced methylation of CpG islands in DNA, which affects gene transcription and modifies the expression of proto-oncogenes and tumor suppressor genes, may result from insufficient SAM synthesis (163)

A subset of users report sleep changes with evening injections, describing either enhanced sleep quality or occasional restlessness

4.4 Challenges and future directions Although significant progress has been made, key challenges remain, including genetic heterogeneity such as MTHFR variants complicating folate dosing, limited clinical validation of oxidative stress biomarkers for infertility, and reliance on animal models, highlighting the need for human RCTs with stratified cohorts (Vitagliano et al., 2021