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Moreover, smooth-fitting curve analysis identified a threshold effect: below 358.7 pg/mL, each 10 pg/mL increase in vitamin B12 was associated with a 4.4% increase in clinical pregnancy rate (OR = 1.04, P = 0.03), beyond which no further benefit was observed

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Intrinsic factor (a protein made in the stomach) binds to B12

People assigned to the higher-dose groups usually started lower, then increased their dose every 4 weeks to make the drug easier to tolerate