SERPINA7 and hyperestrogenism: In the current study, the major differences between women achieving pregnancy and those who experienced implantation failure were in serum T4, fT4 levels and the T4/T3 ratio, This discrepancy among TSH,T4 and fT4 levels might be explained by the physiology: COS-induced hyperestrogenism directly reduces serum fT4 levels by stimulating thyroid binding globulin (TBG) production, whereas the increase in serum TSH levels is achieved by a negative feedback loop [27, 28].