A slide deck is not a document, and the conversion has to decide what a slide even means in prose. Each slide contributes its title as a line of text followed by its bullets, and the deck reads top to bottom in slide order. Worth knowing before you paste the result anywhere: a slide title does not become a Markdown heading. PowerPoint treats a title as a placeholder with a particular position and style, not as a level in a hierarchy — a fifty-slide deck has fifty titles and no sense of which outrank which — so nothing in the file says what depth a heading would be. If you want an outline, the # marks are yours to add.
That arrangement is exactly what does not survive. A .pptx is a zip with one XML part per slide, and each shape in it carries coordinates, a z-order, an animation timeline and a link to a layout and a master. None of that has a Markdown equivalent, so two text boxes side by side come out one after the other.
More of the deck survives than you might expect. Speaker notes, which live in their own notesSlide parts, are appended to each slide as a blockquote rather than dropped — so a deck whose substance is in the notes still converts usefully, and a deck whose notes are private is worth checking before you paste the output anywhere. Text inside grouped shapes is read, so a diagram assembled out of grouped boxes gives up its labels instead of vanishing. Tables placed on a slide come through as real Markdown tables, which is the one structural thing a deck has that Markdown can represent exactly.