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Given the numerous potential secondary causes, the PIANIST mnemonic (Psychiatric, Iatrogenic/Intoxicant, Anemia, Nutrients, Infection, Sleep, Thyroid/hormonal) can be used to aid in identification (Table 1)

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effects on clinical pregnancy and live birth rates were less consistent across treatments, although testosterone supplementation showed a statistically significant live-birth improvement (odds ratio 2.19, 95% CI 1.114.32)