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The underlying mechanisms are versatile and encompass hormonal alterations due to hypothalamic-pituitary-ovarian axis disruption, derailed metabolism (insulin resistance, hyperglycemia, dyslipidemia), chronic inflammation (elevated levels of proinflammatory cytokines, e.g., IL-6, IL-1β, TNF-α) and mitochondrial dysfunction (enhanced oxidative stress, apoptosis, mitochondrial DNA damage) that ultimately induce alterations in the ovarian follicle microenvironment, that have been extensively reviewed elsewhere (Silvestris et al., 2018

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Determination of GSH-Px activity in organism can be an indicator of selenium level as Se is essential section of GSH-Px