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The existence of distinct phenotypes, and the fact that no animal model of the bulbar phenotype exists, combined with well-documented differences in response to medications across phenotypes in humans, further complexifies the investigation of the potential benefits of microbiome-based interventions in this condition

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Besides their role in inflammation, these cytokines are detrimental to the processes of fertilization and embryo development: TNF-α increases the free implants adhesions and their invasiveness through its effect on matrix metallo-proteinases (157) while TGF-β hinders the local immune activity by inhibiting the natural killer cells which in turn impede the development of embryos (158)