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Oxidative stress is accepted to be the main contributing factor, with sperm quality and quantity affected by the overproduction of free radicals

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& Sobolevsky, A

SNPs in three genes, namely, folylpoly--glutamate synthase ( FPGS ), -glutamyl hydrolase ( GGH ), and folate carrier ( SLC19A1 ), have been reported as potential predictors of toxicities and efficacy after therapy with pemetrexed [9, 10, 17]

However, published evidence relates primarily to the individual peptide components, and should not be interpreted as demonstrating equivalent findings for the combined blend