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These cases have led to growing interest in identifying non-hormonal contributors to disease burden, including immune system activation, micronutrient malabsorption, and alterations in the gut microbiota

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One such pathway involves the rapid stimulation of phospholipase C (PLC), which facilitates inositol trisphosphate-mediated calcium release from intracellular stores

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Specifically, BMP15 and GDF9 secreted by oocytes normally activate the TGF signaling pathway, promoting granulosa cell proliferation, differentiation, and functional maintenance, thereby supporting oocyte maturation and normal follicular development