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We did not observe negative changes in the cytoplasm or in the perivitelline space, so the last two possibilities are most likely

Normal blood flow (NBF) inside the spermatic veins, with normal scrotal temperature

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Key Insights: Identifies systemic modulators (cortisol, sex hormones, sleep, NAD) that may influence OTM Evidence-grading adapted from Oxford CEBM 2011 Levels of Evidence Stratifies interventions from evidence-based (aspirin caution, menstrual cycle timing) to hypothesis-generating (NMN supplementation, Zone 2 training) Why This Matters: Identical mechanical protocols produce vastly different clinical responses