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In: Human Semen Analysis: From the WHO Manual to the Clinical Management of Infertile Men

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A key regulatory mechanism involves activation of the Nrf2/ARE signaling pathway, which upregulates antioxidant enzymes such as heme oxygenase-1 (HO-1) and NAD(P)H quinone oxidoreductase-1 (NQO1), thereby reducing oxidative stress–induced endothelial dysfunction and atherosclerotic plaque formation (Minj and Satapathy, 2025)