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DHODH activity is essential for proliferating cells owing to their increased demand for nucleotides, and DHODH inhibition has long been studied as a therapeutic strategy in autoimmune diseases (for example, via leflunomide) and cancer, where it can lead to cell cycle arrest, DNA damage and replication stress 42,44,45

Collectively, these findings support the role of fecal microbiota influences and metabolic pathways (oxidative stress, inflammation) as underlying mechanisms for the beneficial effects of the MD in reproductive health, highlighting microbiota manipulation and metabolic interventions as promising avenues for further exploration (72)