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Cho MG, Kumar RJ, Lin CC, Boyer JA, Shahir JA, Fagan-Solis K, et al

Successful sermorelin therapy depends on protocol adherence and professional oversight

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Essentially, theres a trade-off between spend and efficiency, which occurs because: The highest-intent audience (the low hanging fruit) has already been converted in the first few runs of the ad Expansion requires reaching less relevant or more expensive audiences to reach, harming average performance Ad fatigue sets in for audiences that are repeatedly exposed to your ads, hence they stop paying attention Diminishing returns means theres a ceiling to how much you can spend in a channel before it gets saturated