We have Akismet activated. Akismet does not flag it. See background on Are you experiencing AI based spam? - #13 by guidoleenders. In our case, using hotmail etc. is not possible, but then they revert to using temporary domains. Messages are quite well-crafted and seem realistic and relevant probably for most readers not looking for spam.
In the cases we have seen there are indeed sometimes replies without links and sometimes a double link is contained on the first reply.