Peritoneal macrophages and infertility: the association between cell number and pelvic pathology
|
|
- Gabriella Hudson
- 5 years ago
- Views:
Transcription
1 FERTILITY AND STERILITY Copyright 1985 The American Fertility Society Vol. 44, No. 6, December 1985 Printed in U.S.A. Peritoneal macrophages and infertility: the association between cell number and pelvic pathology David L. Olive, M.D. *t J. Brice Weinberg, M.D.:j: Arthur F. Haney, M.D.* Duke University Medical Center and Veterans Administration Medical Center, Durham, North Carolina Increased numbers of peritoneal macrophages have been repeatedly associated with infertility. Because the factors contributing to this intraperitoneal exudate are unknown, this study was carried out to determine which anatomic or endocrinologic abnormalities in infertile women might be associated with an increase in leukocyte numbers. The peritoneal fluid from 103 women was analyzed. Nonparametric data analysis demonstrated significantly greater cell counts in infertile women with endometriosis, compared with other infertile women (P < 0.01) or fertile control subjects (P < 0.005). Multiple regression analysis was then used to determine the relationship of individual variables to cell number without the influence of confounding factors. These data demonstrate that the best correlation with elevated macrophage number is in women who have infertility and no mechanical fertility factors (of which mild endometriosis is a subgroup). Thus, an increase in peritoneal macrophage number is not restricted to women with endometriosis but, rather, is seen in a subset of infertile women generally without mechanical or endocrinologic infertility factors. Fertil Steril 44:772, 1985 Increased numbers of peritoneal macrophages have been repeatedly associated with infertility. 1-3 Phagocyte-mediated cytotoxicity has been demonstrated for sperm, 4 oocytes, 5 and preimplantation embryos. 6 Furthermore, a localized inflammatory exudate with its attendant leukocyte cytotoxicity has been strongly implicated as the mechanism of action of intrauterine con- Received June 12, 1985; revised and accepted August 21, *Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center. tpresent address and reprint requests: David L. Olive, M.D., University of Arkansas Medical School, 4301 West Markham, Slot #518, Little Rock, Arkansas *Veterans Administration Medical Center and Division of Hematology/Oncology, Department of Medicine, Duke University Medical Center. 772 Olive et al. Peritoneal macrophages and infertility traceptive devices. 7-9 These facts together have led us to postulate that an intraperitoneal inflammatory process adversely influences fertility. The factors contributing to this intraperitoneal inflammation are unknown. Several previous studies noted increased numbers of macrophages in association with endometriosis. 1-3 However, these investigations used heterogeneous control groups and did not correct for potentially confounding variables. As a consequence, the precise relationship between infertility, peritoneal macrophage number, and pelvic pathology has not been well defined. This study was undertaken to delineate those factors that are associated with elevated numbers of peritoneal macrophages. A variety of anatomic and endocrinologic abnormalities are evaluated to identify the role of each in the genesis of intraperitoneal inflammation in infertile women. Fertility and Sterility
2 Table 1. Frequency of Occurrence of Variables Variable No. % Fertile Infertile lndeterminatea Adhesions No adhesions Tubal obstruction Patent tubes Ovulatory dysfunction Normal ovulation Endometriosis No endometriosis Leiomyomata No leiomyomata ~hese patients are excluded for the remainder of the analysis. MATERIALS AND METHODS One hundred three women who underwent laparoscopy or laparotomy at Duke University Medical Center comprised the population of this study. The couples had been unable to conceive for at least 1 year. Patients with a history of salpingooophoritis had been free of all signs and symptoms of active infection for at least 1 year. All experiments were conducted with the approval of the Duke University Clinical Investigation Committee, and all patients gave informed consent. At the time of operation, all patients were classified as to the presence or absence of the following: (1) endometriosis, (2) leiomyomata, (3) pelvic adhesions significantly distorting normal pelvic anatomic relationships, ( 4) bilateral tubal obstruction, and (5) ovulatory dysfunction. If endometriosis was present, patients were classified according to the revised classification system of The American Fertility Society (R-AFS). 10 Infertile couples having a male factor (as judged by semen analysis), poor postcoital tests, or significant uterine anomalies were excluded from analysis. Peritoneal fluid (PF) was obtained during laparoscopy as previously describedy Briefly, the fluid was aspirated from the anterior uterovesical space and posterior cul-de-sac through a hollow cannula under direct vision; all of the free PF was removed. The fluid was anticoagulated with 10 U sodium heparin/ml PF and chilled on ice. Ten to 20 J.Ll of PF was diluted 1 to 10 with Turk's blooddiluting fluid (Ricca Chemical Company, Ar- lington, TX), and the white cells were counted. The volume ofpf was then measured to the nearest 0.1 ml and the number ofmacrophages determined. Differential cell counts revealed ~ 90% macrophages consistently, as noted in previous studies Because of the skewed distribution of the data collected, nonparametric statistical analysis was believed to be mandatory. Statistical analysis for pairwise comparisons of groups (i.e., infertile women with endometriosis versus fertile control subjects, etc.) was carried out with the use of the Wilcoxon two-sample test with continuity correction. 13 To determine the relative influence of a single factor upon fluid volume and cell number unencumbered by the effects of other potentially confounding factors, multivariate analysis was performed by the maximum R 2 improvement technique for stepwise regression analysis of multiple independent variables. 14 Correlation coefficients for linear regression analysis between PF volume and total cell number, as well as for comparison of R-AFS point totals to fluid volume and cell number, were performed nonparametrically with the use of the Spearman rank-order test. RESULTS Of the 103 patients evaluated, 78 were infertile at the time of laparoscopy, 19 were parous controls currently undergoing tubal ligation or reanastomosis, and 6 had not attempted conception, so their fertility potential was unknown. The rate of occurrence of each of the variables studied is seen in Table 1. The 42 patients with endometriosis were classified by the R-AFS 10 system as having minimal disease (26 patients, 61.9%); mild disease (8 patients, 19.0%); moderate endometriosis (7 patients, 16. 7%); and severe disease (1 patient, 19.0%) (Fig. 1). Initially, analysis was done on three groups: I, infertile with endometriosis; II, infertile without endometriosis; and III, fertile control subjects. The analysis of the PF volume and total cell number can be seen in Table 2. No significant differences were demonstrated among the three groups when PF volume was evaluated. PF cell number, however, was significantly greater in infertile endometriosis patients than in other infertile women (P = 0.007) or fertile control subjects (P = ). Vol. 44, No.6, December 1985 Olive et al. Peritoneal macrophages and infertility 773
3 lljjld 0 0:111,p I 0 0 I MINIMAL 5 0,~8 MILD MODERATE SEVERE l8 57 Endometriosis Point Total Figure 1. Endometriosis patient distribution by pomt totals and.stag~ of disease. The women were scored with the R-AFS classification system with minimal, 1 to 5 points; mild, 6. to 15 points; moderate, 16 to 40 points; and severe, > 40 pomts. Therefore, given this association, an attempt was made to determine which findings in the infertile patient might be responsible for the increase in PF cell number. With the use of the infertile patients exclusively (n = 78), multiple regression analysis was carried out for determination of the individual contribution by each of the five variables. Analysis of fluid volume showed that none of the factors investigated seemed to be correlated with an increased volume (Table 3). However, the absence of adhesions (P = 0.002) and ovulatory dysfunction (P = 0.048) did correlate with an increased amount of fluid; i.e., an infertile woman was more likely to have fluid elevation if she did not have significant adhesions or ovulatory dysfunction. Similarly, the absence of tubal obstruction nearly correlated with significant fluid increase (P = 0.084). The presence or absence of endometriosis or leiomyomata, however had no demonstrable association with fluid ' volume. The analysis of total cell number also revealed that none of the factors tested correlated with an increased count. Patients without adhesions, however, did have a higher cell number than Table 2. Characteristics of PF Patient group No. Volume" Cell no." ml X 10 6 I. Infertile with en do ± ± 4.2 metriosis II. Infertile without en ± ± 1.9 dometriosis III. Fertile control sub ± ± 2.5 jects amean ± standard error. those with adhesive disease (P = 0.009) (Table 4). Based on these findings, it was of interest to single out those patients who had no confounding variables in order to view the data in "pure" populations. For patients with endometriosis and leiomyomata as well as those patients with no identifiable infertility factors, the results can be seen in Table 5. Each of these groups has high fluid volumes and cell numbers, with the total generated being the highest yet identified for a subpopulation of infertile women. It thus appears that the best correlation with increased macrophage number and fluid volume is not a unique pathologic diagnosis but rather the presence of infertility without a mechanical cause. Among patients with implants of endometriosis, the relationship between point total by the R-AFS classification system 10 and total fluid volume or cell number was calculated. The Spearman correlation coefficient was significantly negative for R-AFS score, versus total volume (r = , P = 0.04); and R-AFS score, versus total cell number (r = , P = 0.02). Thus, lower R-AFS scores were associated with greater amounts of fluid and higher cell counts, demonstrating that the extent of disease does not contribute to a higher PF cell number. Finally, the relationship between fluid volume and cell number among all patients can be seen in Figure 2. The correlation coefficient for this distribution is 0.62, differing significantly from 0 (P < 0.01). Thus, to a significant degree the amount of PF reflects the cell count. DISCUSSION High numbers of peritoneal macrophages have been noted repeatedly in infertile women. Furthermore, the peritoneal macrophage number has a direct relationship to the number of intratubal macrophages. 15 Adverse effects of leukocytes upon the reproductive process are well known to the reproductive biologist. Cell-mediated cytotoxicity toward human spermatozoa has been demonstrated in the female reproductive tract both in vivo 4 and in vitrop 16 Similarly, oocyte cytotoxicity has been demonstrated in vitro in an animal model. 5 Animal 6 7 and human 7 8 studies have noted an intrauterine cellular inflammatory response secondary to intrauterine contraceptive devices, and recent evidence suggests leukocytemediated damage to the preimplantation embryo 774 Olive et al. Peritoneal macrophages and infertility Fertility and Sterility
4 Table 3. Multiple Regression Analysis for Total PF Volume Among Infertile Women Paired variables B value" F p Adhesions versus no adhe sions Ovulatory dysfunction ver sus normal ovulation Tubal obstruction versus pa tent tubes Leiomyomata versus no leiomyomata Endometriosis implants ver sus no endometriosis implants athe B values indicates with which member of the pair a significant correlation is associated (if one exists). A positive value indicates increased volume with the first variable of the pair; a negative value indicates a correlation with the second variable. in the intrauterine-device-bearing monkey. 6 Increased levels of proteolytic enzymes have also been demonstrated in the PF of infertile women.17 These findings together suggest that an inflammatory reaction is present in the peritoneal cavity of a subgroup of infertile women. Despite the identification of an intraperitoneal inflammatory exudate in infertile women, it remains to be determined what factors govern this phenomenon. Three previous studies have addressed the relationship between PF cell number and endometriosis, and all found increased numbers of PF macrophages. In the first report, infertile women with endometriosis were compared with a group of infertile women without endometriosis and a group of fertile control subjects. 1 Halme and associates 3 used similar comparison Table 4. Multiple Regression Analysis for Total Cell Number Among Infertile Women Paired variables B value" F p Adhesions versus no adhe sions Tubal obstruction versus pa tent tubes Ovulatory dysfunction ver sus normal ovulation Endometriosis implants ver sus no endometriosis implants Leiomyomata versus no leiomyomata athe B values indicates with which member of the pair a significant correlation is associated (if one exists). A positive value indicates increasing cell number with the first variable of the pair; a negative value indicates a correlation with the second variable. Table 5. Characteristics of PF in Unexplained Infertile Populations Patient group No. Volume" Cell no." ml X 106 Unexplained infertility ± ± 9.7 Endometriosis implants ± ± 6.7 only Leiomyomata only ± ± 9.2 Total ± ± 5.1 amean ± standard error. groups with nearly identical findings, although parametric statistics were used in an obviously skewed sample. Finally, Badawy and colleagues 2 compared infertile endometriosis patients with a mixed control group of other infertile patients and fertile sterilization candidates. Their results are in agreement with the other studies, despite the use of parametric statistical testing in a nonnormal distribution. Although these studies demonstrate that elevated PF macrophage counts are associated with infertility and endometriosis, they cannot address the cause of the inflammatory process. We have attempted to determine in this investigation which anatomic or endocrinologic findings were independently associated with high PF leukocyte :90 iso E ~ 70 ~ 60 a ~50 0 ~ ~ 30-0 ~ : Total Peritoneal Fluid Volume (ml) Figure 2 Total PF volume versus total number ofperitonealleukocytes. Nonparametric linear regression analysis revealed the distribution to have a significant correlation (r = 0.62, P < 0.01). Vol. 44, No.6, December 1985 Olive et al. Peritoneal macrophages and infertility 775
5 14 12 :;;10 "" ~8 z 'Es ~ CJ C o~~~~~~~~~~~~~~~~- Figure 3 Distribution of total peritoneal leukocyte counts in 29 women with no mechanical or endocrinologic cause for infertility: unexplained infertility, endometriosis implants alone, and leiomyomata only. counts. To test the association of these factors, the use of muitiple regression analysis was felt most appropriate. This technique mathematically normalizes the effect of any confounding variabies so that the true effect of the presence or absence of a single factor can be evaluated. In performing this analysis in infertile women, the presence or absence of endometriotic implants, leiomyomata, tubal obstruction, or ovulatory dysfunction did not appear to influence the peritoneal leukocyte count. The only significant relationship was a negative one, i.e., the presence of a mechanical problem (i.e., adhesions) was associated with lower macrophage counts. Similar findings were noted with PF volume. Based on these data, the subset of infertile women with high intraperitoneal macrophage counts is that group without identifiable mechanical or endocrinologic causes of infertility. Thus, despite the absence of a direct relationship between endometriosis and high macrophage counts, women with milder degrees of endometriosis would be expected to segregate disproportionally more often into that subset. Supporting this is the finding that significantly higher macrophage counts were observed in women with low R-AFS endometriosis scores and no anatomic distortion, compared with those with high scores and presumably considerable anatomic distortion. Given this concept, it is understandable why previous studies, having included patients primarily with mild disease, repeatedly demonstrated a strong association between endometriosis and high intraperitoneal cell counts. Combining all patients without mechanical or endocrinologic causes for infertility, a sub- population was produced with the highest aggregate peritoneal cell number of any report to date (Table 5). Even still, a review of these 29 women with unexplained infertility reveals a bimodal distribution, with roughly half having highly elevated macrophage levels, whereas half had normal cell counts (Fig. 3). Thus, although leukocyte-mediated cytotoxicity might be responsible for some previously unexplained infertility, it does not account for all such patients. Although the occasional patient may have two coexisting problems, the number of high-leukocyte women should be fairly small in the groups of infertile women with a clearly identifiable mechanical or endocrinologic explanation for their low fecundity. This is precisely what is found in this study, with the fewest number of patients with high PF macrophage numbers being seen in women with pelvic adhesions and resultant anatomic distortion. Thus, the previously demonstrated association between endometriosis and elevated peritoneal macrophage number is a complex relationship, and the pathogenesis of these two findings may be governed by independent factors. The common denominator that may link these two pathologic entities is retrograde menstruation. This phenomenon may well be near universal,18 19 and the ability of the endometrial cell to ectopically implant may be related to decreased lymphocytotoxicity directed toward endometrial antigens It may well be that intraperitoneal inflammation and leukocytosis is a response by some women to the process (retrograde menstruation), rather than the occasional consequence of that process (endometriosis implants) Conversely, the possibility exists that this finding is totally unrelated to the development of endometriosis and may represent an associated but independent entity. Further investigation into the origin and effects of elevated numbers of peritoneal macrophages is clearly needed to fully understand its relationship to infertility. In summary, this study extends our previous work that demonstrates an association between macrophage-mediated cytotoxicity and infertility. We have shown that elevated numbers of macrophages are not exclusive to women with endometriosis but rather correlate best with infertility in the absence of mechanical or endocrinologic disorders. This suggests that women with high peritoneal leukocyte counts represent a dis- 776 Olive et al. Peritoneal macrophages and infertility Fertility and Sterility
6 tinct group of infertile patients in which women with minimal or mild endometriosis are a subset. Acknowledgments. We would like to thank Kerry L. Lee, Ph.D. for his time and assistance in the statistical calculations needed, and Ms. Marcia Hobbs and Ms. Mary Misukonis for their able assistance in the laboratory. REFERENCES 1. Haney AF, Muscato JJ, Weinberg JB: Peritoneal fluid cell populations in infertility patients. Fertil Steril 35:696, Badawy SZA, Cuenca V, Marshall L, Munchback R, Rinas AC, Coble DA: Cellular components in peritoneal fluid in infertile patients with and without endometriosis. Fertil Steril 42:704, Halme J, BeckerS, Hammond MG, Raj S: Pelvic macrophages in normal and infertile women: the role of patent tubes. Am J Obstet Gynecol 142:890, Austin CR: Fate of spermatozoa in the female genital tract. J Reprod Fertil 1:151, Weissmann G, Finkelstein MC, Csernansky J, Quigley JP, Quinn RS, Techner L, Troll W, Dunham PB: Attack of. sea urchin eggs by dogfish phagocytes: model of phagocyte-mediated cellular cytotoxicity. Proc Natl Acad Sci USA 75:1825, Hurst PR, Jefferies K, Eckstein P, Dawson K, Whealer AG: Leukocytes are consistently associated with degenerating embryos in IUD-bearing rhesus monkeys. Nature 269:331, Joshi SG: Local effects of pharmacologically inert IUDs in rats, baboons, and humans. In Analysis of Intrauterine Contraception, Edited by F Hefnawi, SJ Segal. New York, American Elsevier, 1974, p Gawad AHA, Toppozada HK, Sawi ME, Saleh F, El Sahwi S: Study of the uterine environment in association with intrauterine contraceptive devices. Contraception 16:469, El-Habashi M, El-Sahwi S, Gawish S, Osman M: Effects of Lippes loop on sperm recovery from human fallopian tubes. Contraception 22:549, American Fertility Society: Revised American Fertility Society Classification of Endometriosis: Fertil Steril 43:351, van Furth R, Raeburn JA, van Zwet TL: Characteristics of human mononuclear phagocytes. Blood 54:485, Muscato JJ, Haney AF, Weinberg JB: Sperm phagocytosis by human peritoneal macrophages: a possible cause of infertility in endometriosis. Am J Obstet Gynecol 144: 503, Wilcoxon F: Individual comparisons by ranking methods. Biometrics 1:80, Sail J, SAS Regression Applications, Technical Report A-102. Cary, NC, SAS Institute, Haney AF, Misukonis MA, Weinberg JB: Macrophages and infertility: oviductal macrophages as potential mediators of infertility. Fertil Steril 39:310, London SN, Haney AF, Weinberg JB: Macrophages and infertility: enhancement of human macrophage-mediated sperm killing by antisperm antibodies. Fertil Steril 43:274, Halme J, BeckerS, Hammond MG, Raj MHG, Raj S: Increased activation of pelvic macrophages in infertile women with mild endometriosis. Am J Obstet Gynecol 145:333, Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM: Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol 64:151, Blumenkratz MT, Gallagher N, Bashore RA, Tenckhoff H: Retrograde menstruation in women undergoing chronic peritoneal dialysis. Obstet Gynecol 57:667, Dmowski WP, Steele RW, Baker GF: Deficient cellular immunity in endometriosis. Am J Obstet Gynecol 141: 377, Steele RW, Dmowski WP, Marmer DJ: Immunologic aspects of human endometriosis. Am J Reprod Immunol 6:33, Olive DL, Hammond CB: Endometriosis: pathogenesis and mechanisms of infertility. Postgrad Obstet Gynecol 5(9):1, Olive DL, Haney AF: Endometriosis. In Reproductive Failure, Edited by AH DeCherney. New York, Churchill Livingstone. In press Vol. 44, No. 6, December 1985 Olive et al. Peritoneal macrophages and infertility 777
Endometrial tissue in peritoneal fluid
FERTILITY AND STERILITY Copyright c 1986 The American Fertility Society Printed in UBA. Endometrial tissue in peritoneal fluid Delphine Bartosik, M.D. *t Samuel L. Jacobs, M.D.* Lynda J. Kelly, C.T.:J:
More informationme LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS
FERTILITY AND STERILITY Copyright c 980 The American Fertility Society Vol. 33,, JanuaEY 980 Printed in U.S.A. me LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS W. PAULDMOWSKI, M.D.,.PH.D.*
More informationThe natural killer activity of peritoneal fluid lymphocytes is decreased in women with endometriosis*
FERTILITY AND STERILITY Copyright 1992 The American Fertility Society Printed on ocid-free paper in U.S.A. The natural killer activity of peritoneal fluid lymphocytes is decreased in women with endometriosis*
More informationEndometriosis impairs the efficacy of gamete intrafallopian transfer: results of a case-control study*
FERTILITY AND STERILITY Vol. 62, No. 6, December 1994 Copyright 1994 The American Fertility Society Printed on acid-free paprr in U. 8. A. Endometriosis impairs the efficacy of gamete intrafallopian transfer:
More informationA factor inhibiting ovum capture by the oviductal fimbriae present in endometriosis peritoneal fluid
FERTILITY AND STERILITY Copyright ~ 1986 The American Fertility Society Vol. 46, No.6, December 1986 Printed in U.SA. A factor inhibiting ovum capture by the oviductal fimbriae present in endometriosis
More informationChapter 7 Infertility, Contraception, and Abortion
Chapter 7 Infertility, Contraception, and Abortion Infertility Incidence Affects about 10% to 15% of reproductive-age population Subfertility: prolonged time to conceive Sterility: inability to conceive
More informationSALPINGITIS IN OVARIAN ENDOMETRIOSIS
FERTILITY AND STERILITY Copyright 1978 The American Fertility Society Vol. 30, No. 1, July 1978 Printed in U.S.A. SALPINGITIS IN OVARIAN ENDOMETRIOSIS BERNARD CZERNOBILSKY, M.D.*t ALAN SILVERSTEIN, M.D.
More informationResults of microsurgical reconstruction in patients with combined proximal and distal tubal occlusion: double obstruction
FERTILITY AND STERILITY Copyright 987 The American Fertility Society Printed in U.S.A. Results of microsurgical reconstruction in patients with combined proximal and distal tubal occlusion: double obstruction
More informationFertility after ectopic pregnancy
Gynecology-endocrinol.ogy FERTILITY AND STERILITY Copyright 1993 The American Fertility Society Vol. 60. No.2, August 199:1 Printed on acid-free paper in U. S. A. Fertility after ectopic pregnancy Steven
More informationIndian Journal of Basic and Applied Medical Research; September 2015: Vol.-4, Issue- 4, P
Original article: To study post intrauterine insemination conception rate among infertile women with polyp and women with normal uterine endometrium cavity 1Dr. Archana Meena, 2 Dr. Renu Meena, 3 Dr. Kusum
More informationLaparoscopic cautery in the treatment of endometriosis-related infertility
4 4 FERTILITY AND STERILITY Copyright ID 1991 The American Fertility Society Printed on acid-free paper in U.S.A. Laparoscopic cautery in the treatment of endometriosis-related infertility Ana A. Murphy,
More informationSperm Surface Antibodies: IUI vs. IVF Treatment
Research Article Sperm Surface Antibodies: IUI vs. IVF Treatment Afaf Felemban MD*, Seham M. Hassonah MD, Najla Felimban KD, Hadeel Alkhelb MD, Samar Hassan MD, Fahad Alsalman MD Department of Obstetrics
More information(Received 5th July 1968)
EFFECT OF AN INTRA-UTERINE DEVICE ON CONCEPTION AND OVULATION IN THE RHESUS MONKEY W. A. KELLY, J. H. MARSTON and P. ECKSTEIN Department of Anatomy, Medical School, Birmingham 15 (Received 5th July 1968)
More informationSecond-look laparoscopy after ectopic pregnancy*
FERTILITY AND STERILITY Copyright 10 1990 The American Fertility Society Printed on acid-free paper in U.S.A. Second-look laparoscopy after ectopic pregnancy* Per Lundorff, M.D.t Jane Thorburn, M.D., Ph.D.
More informationProtein, progesterone, and protease inhibitors in uterine and peritoneal fluids of women with endometriosis*
FERTILITY AND STERILITY Vol. 47, No.2, February 1987 Copyright 1987 The American Fertility Society Printed in U.8A. Protein, progesterone, and protease inhibitors in uterine and peritoneal fluids of women
More informationPELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED
FERTU.ITY AND STERILITY Copyright " 1981 The American Fertility Society Vol. 36, No. 6, December 1981 Printed in U.S A. PELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED DONALD
More informationCharacterization of leukocyte subpopulations in the peritoneal fluid of women with endometriosis*t
FERTILITY AND STERILITY Copyright 0 1988 The American Fertility Society Vol. 50, No. 2, August 1988 Printed in U.S.A. Characterization of leukocyte subpopulations in the peritoneal fluid of women with
More informationDiagnostic laparoscopy in primary and secondary infertility
Diagnostic laparoscopy in primary and secondary infertility Al-Sakkkal Ghada Saddallah C.A.B.O.G. Department of Obs. And Gyn., Hawler Medical University ABSTRACT Objective: To compare the diagonstic effficacy
More informationEVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD
EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve
More informationAbstract. Introduction. RBMOnline - Vol 19. No Reproductive BioMedicine Online; on web 12 October 2009
RBMOnline - Vol 19. No 6. 2009 847 851 Reproductive BioMedicine Online; www.rbmonline.com/article/4130 on web 12 October 2009 Article Significance of positive Chlamydia serology in women with normal-looking
More informationPOST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE. Anatomy : Male and Female genital tract
POST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE DURATION OF THE COURSE : TWO YEARS Detailed syllabus: Part 1 Basic Sciences: Anatomy : Male and Female genital tract Physiology Endocrinology
More informationCase 1 Dear Dr Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol. General investigation of infertility. Case 3
General investigation of infertility What is relevant in Primary Care? Case 1 Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol Would you please see this couple. Mr and Mrs Baldwin present to the
More informationImpact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles
1 st SEUD Meeting, 9 May 2015, Paris, France Impact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles ENDOMETRIOSIS ovarian endometrioma
More informationAn Overview of Uterine Factors That Influence Implantation
An Overview of Uterine Factors That Influence Implantation Bulent Urman, M.D. Dept. of Obstetrics and Gynecology Koc University School of Medicine Assisted Reproduction Unit, American Hospital, ISTANBUL
More informationFemale Sterilization. Kavita Nanda, MD, MHS FHI 360 Expanding Contraceptive Choice December 6, 2018
Female Sterilization Kavita Nanda, MD, MHS FHI 360 Expanding Contraceptive Choice December 6, 2018 What is female sterilization? Family planning method that provides permanent contraception to women and
More informationDiagnostic L/S: Is it ever indicated? Prof. Dr. Nilgün Turhan Fatih University Medical School
Diagnostic L/S: Is it ever indicated? Prof. Dr. Nilgün Turhan Fatih University Medical School Diagnostic Laparoscopy (DLS) DLS is the gold standard in diagnosing tubal pathology and other intraabdominal
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationManaging infertility when adenomyosis and endometriosis co-exist
Managing infertility when adenomyosis and endometriosis co-exist Jinhua Leng Beijing,China Endometriosis Endometriosis (EM) is a common, benign, ovary hormone-dependent gynecologic disorder which affects
More informationChapter 1. Chapter 2. Chapter 3
Summary To perform IUI some conditions are required. This includes 1) a certain amount of progressively motile spermatozoa, 2) the presence of ovulation, 3) the presence of functional fallopian tubes,
More informationBiology of fertility control. Higher Human Biology
Biology of fertility control Higher Human Biology Learning Intention Compare fertile periods in females and males What is infertility? Infertility is the inability of a sexually active, non-contracepting
More informationLong-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts
Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 50 (2011) 306e311 Original Article Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic
More informationDefinition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus.
Dept. of Obstetrics t and Gynecology Faculty of Medicine University of Sumatera Utara Endometriosis Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the
More informationThe major causes of female infertility include ovulatory dysfunction, tubal and peritoneal
Focused Issue of This Month YoungMin Choi, MD Department of Obstetrics and Gynecology, Seoul National University College of Medicine Email : ymchoi@snu.ac.kr J Korean Med Assoc 2007; 50(5): 400-405 Abstract
More informationENDOMETRIOSIS: ROLE OF OVARIAN STEROIDS IN INITIATION, MAINTENANCE, AND SUPPRESSION
FERTILITY AND STERILITY Copyright e 1980 The American Fertility Society Vol. 33, No.6, June 1980 Printed in U.SA. ENDOMETRIOSIS: ROLE OF OVARIAN STEROIDS IN INITIATION, MAINTENANCE, AND SUPPRESSION GERE
More informationChris Davies & Greg Handley
Chris Davies & Greg Handley Contents Definition Epidemiology Aetiology Conditions for pregnancy Female Infertility Male Infertility Shared infertility Treatment Definition Failure of a couple to conceive
More informationPREGNANCY AND RECURRENCE RATES IN INFERTILE PATIENTS OPERATED FOR OVARIAN ENDOMETRIOSIS
Rev. Med. Chir. Soc. Med. Nat., Iaşi 2015 vol. 119, no. 1 SURGERY ORIGINAL PAPERS PREGNANCY AND RECURRENCE RATES IN INFERTILE PATIENTS OPERATED FOR OVARIAN ENDOMETRIOSIS Monica Holicov Luţuc 1, D. Nemescu
More information1 - Advanced clinical course for ART with Hands on
1 of 7 1 - Advanced clinical course for ART with Hands on Duration: 30 days Course Fee: Rs 1,00,000 I. Anatomy & Physiology of Male & Female reproduction. II. Evaluation of infertile couple III. Counselling
More informationLUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY*
FERTILITY AND STERILITY Copyright c 1978 The American Fertility Society Vol. 29, No.3, March 1978 Printed in U.S.A. LUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY* JAROSLA V MARIK,
More informationRole of intrauterine tubo-peritoneal insemination and intrauterine insemination in the treatment of infertility
International Journal of Research in Medical Sciences Gupta D et al. Int J Res Med Sci. 2017 May;5(5):2057-2061 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171842
More informationPRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018
PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 Clinical Assessment A thorough clinical evaluation is a prerequisite for ART A thorough clinical evaluation as detailed in the female and male
More informationInflammatory changes of the endometrium in patients with minimal-to-moderate endometriosis*t
FERTILITY AND STERILITY Vol. 62, No.5, November 1994 Copyright e 1994 The American Fertility Society Printed on acid.. free paper in U. S. A Inflammatory changes of the endometrium in patients with minimal-to-moderate
More informationFertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr.
Dr. Shahin Ghadir A Primary Care Approach to Diagnosing and Treating Infertility St. Charles Bend Grand Rounds November 30, 2018 I have no conflicts of interest to disclose. + About SCRC State-of-the-art
More informationOne Thousand Cases of Infertility
One Thousand Cases of Infertility Clinical Review of a Five-Year Series Robert B. Wilson, M.D. THE RECORDS of 1032 women who complained of infertility have been reviewed. These patients were seen by various
More informationReproductive Endocrinology and Infertility Rotation Objectives. Reproductive Endocrinology and Infertility Specialists
Reproductive Endocrinology and Infertility Rotation Objectives Reproductive Endocrinology and Infertility Specialists Terry O Grady M.D., FRCSC Sarah Healey M.D., FRCSC Deanna Murphy M.D., FRCSC Sean Murphy
More informationWhat You Should Know About Pelvic Adhesions & Gynecologic Surgery
ETHICON, a Johnson & Johnson company, is dedicated to providing innovative solutions for common women s health conditions. Our goal is to provide you access to advanced technology and valuable, easy-to-understand
More informationInfertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations
Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should
More informationEndometrial epithelial cells in peritoneal fluid during the early follicular phase*
RTILITY AND STRILITY opyright 1991 The American ertility Society Vol. 55, No.2, ebruary 1991 Printed on acid free paper in.s.a. ndometrial epithelial cells in peritoneal fluid during the early follicular
More informationTUBAL PLASTIC SURGERY is an accepted form of therapy in the treatment
Tubal Plastic Surgery ADNAN MROUEH, M.D., ROBERT H. GLASS, M.D., and C. LEE BUXTON, M.D. TUBAL PLASTIC SURGERY is an accepted form of therapy in the treatment of infertility. However, reports have differed
More informationPalm Beach Obstetrics & Gynecology, PA
Palm Beach Obstetrics & Gynecology, PA 4671 S Congress Avenue 4631 N Congress Avenue Lake Worth, FL 33461 West Palm Beach, FL 33407 INSTRUCTIONS FOR INFERTILITY WORKUP Please read these handouts carefully.
More informationA COMPARISON OF HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN THE INVESTIGATION OF INFERTILITY
Basrah Journal of Surgery A COMPARISON OF HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN THE INVESTIGATION OF INFERTILITY Fouad Hamad Al-Dahhan * & Zainab Baker @ *FRCOG, Assistant Professor, @ M.B.Ch.B. Department
More informationSurgical Management of Endometriosis associated Infertility
Surgical Management of Endometriosis associated Infertility Dr. Ingrid Lok Specialist in Obstetrics and Gynaecology (Honorary Clinical Associate Professor, CUHK) HA commission training 24.2.2014 Endometriosis
More informationMedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.018.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2017
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.018.MH Infertility- Treatment This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar
More informationInfertility for the Primary Care Provider
Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have
More informationThe length of the fertile window is associated with the chance of spontaneously conceiving an ongoing pregnancy in subfertile couples
Human Reproduction Vol.22, No.6 pp. 1652 1656, 2007 Advance Access publication on April 20, 2007 doi:10.1093/humrep/dem051 The length of the fertile window is associated with the chance of spontaneously
More informationFertility Following Myomectomy
Fertility Following Myomectomy FRANCIS M. INGERSOLL, M.D. MYOMECTOMY is an operation frequently indicated in both the maitied and the single woman who desires to preserve her child-bearing function. The
More information(DES) exposure, congenital anomalies or intrauterine disease (P = 0.03), and history of chlamydia infection (P = 0.02).
formed during the follicular phase by one of the authors (G.D.A.) with patients' prior informed consent. Some patients also had other infertility factors that were treated whenever possible. From February
More informationComparison of hysterosalpingography and laparoscopy in predicting fertility outcome
Human Reproduction vol.14 no.5 pp.1237 1242, 1999 Comparison of hysterosalpingography and in predicting fertility outcome Ben W.J.Mol 1,2,5, John A.Collins 3,4, Elizabeth A.Burrows 4, Fulco van der Veen
More informationIN VITRO FERTILIZATION OF RABBIT EGGS IN OVIDUCT SECRETIONS FROM DIFFERENT DAYS BEFORE AND AFTER OVULATION*
FERTILITY AND STERILITY Copyright~ 1975 The American Fertility Society Vol. 26, No.7, July 1975 Printed in U.SA. IN VITRO FERTILIZATION OF RABBIT EGGS IN OVIDUCT SECRETIONS FROM DIFFERENT DAYS BEFORE AND
More informationEvaluation of the Infertile Couple
Overview and Definition Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. Infertility is a very common condition as in any given year about
More informationAre implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer~*
FERTILITY AND STERILITY Copyright 0 1990 The American Fertility Society Printed on acid-free paper in U.S.A. Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in
More informationLabeling for Permanent Hysteroscopically-Placed Tubal Implants Intended for Sterilization
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Labeling for Permanent Hysteroscopically-Placed Tubal Implants Intended for Sterilization Draft Guidance for Industry and Food and Drug
More informationA multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of
A multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of Endometrioma and deep infiltrating endometriosis Professor C. Chapron and the Group
More informationThe predictive value of idiopathic failure to fertilize on the first in vitro fertilization attempt*
FERTILITY AND STERILITY Copyright 1991 The American Fertility Society Printed on acid-free paper in U.S.A. The predictive value of idiopathic failure to fertilize on the first in vitro fertilization
More informationSperm Survival in Women. Motile Sperm in the Fundus and Tubes of Surgical Cases
Sperm Survival in Women Motile Sperm in the Fundus and Tubes of Surgical Cases Boris B. Rubenstein, M.D., Ph.D.; Hermann Strauss, M.D.; Maurice L. Lazarus, M.D., and Henry Hankin, M.D. THE DURATION of
More informationitoneal fluid from women with moderate or severe endometriosis hibits sperm motility: the role of seminal fluid components*
Urology-alldrology AND STERILITY C> 1996 American Society for Reproductive Medicine Vol. 66, No.5, November 1996 Printed on acid-free paper in U. S. A. itoneal fluid from women with moderate or severe
More informationSurgery and Infertility
Surgery and Infertility Dr Phill McChesney BHB MBChB FRANZCOG MRMed CREI Laparoscopy Prior to Considering IVF Diagnostic Tubal Surgery Treatment of peritubal adhesions Reconstructive surgery Sterilization
More informationARTIFICIAL INSEMINATION USING HOMOLOGOUS SEMEN: A REVIEW OF 158 CASES
- FERTILITY AND STERILITY Copyright < 976 The American Fertility Society VoL 7, No, 6, June 976 Printed in U,S,A, ARTIFICIAL INSEMINATION USING HOMOLOGOUS SEMEN: A REVIEW OF 58 CASES RICHARD E, DIXON,
More informationInfertility: A Generalist s Perspective
Infertility: A Generalist s Perspective Learning Objectives Fertility and Lifestyle: Patient education Describe the basic infertility workup Basic treatment strategies unexplained Heather Huddleston, MD
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationArticle Effect of ovarian involvement on peritoneal fluid cytokine concentrations in endometriosis patients
RBMOnline - Vol 14. No 5. 2007 620-625 Reproductive BioMedicine Online; www.rbmonline.com/article/2742 on web 19 March 2007 Article Effect of ovarian involvement on peritoneal fluid cytokine concentrations
More informationINFERTILITY CAUSES. Basic evaluation of the female
INFERTILITY Infertility is the inability to conceive after 12 months of unprotected intercourse. There are multiple causes of infertility and a systematic way to evaluate the condition. Let s look at some
More informationRealizing dreams booklet.indd 1 5/20/ :26:52 AM
Realizing dreams. 18891booklet.indd 1 5/20/2010 11:26:52 AM The Journey To Parenthood The first Gator Baby was born in 1988 through the in vitro fertilization program at the University of Florida. Since
More informationAssisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi
Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various
More informationMultifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients
FERTILITY AND STERILITY Copyright 99 The American Fertility Society Vol. 56, No.3, September 99 Printed on acid-free paper in U.S.A. Multifactorial analysis of fertility after conservative laparoscopic
More informationSubfertility B Y A L I S O N, B E N A N D J O H N
Subfertility B Y A L I S O N, B E N A N D J O H N Contents Definition Causes Male Female Hx & Ex Investigations Treatment Definition Failure to conceive after a year of frequent, unprotected communion.
More informationSURGICAL TREATMENT OF ENDOMETRIOSIS IN THE INFERTILE FEMALE: A MODIFIED APPROACH
SCIENTlFICARTICLES FERTILITY AND S!'ERILITY Copyright 1979 The American Fertility Society Vol. 32, No.6, December 1979 Printed in USA. SURGICAL TREATMENT OF ENDOMETRIOSIS IN THE INFERTILE FEMALE: A MODIFIED
More informationSurgical treatment of endometriosis: location and patterns of disease at reoperation
Surgical treatment of endometriosis: location and patterns of disease at reoperation Elizabeth Taylor, M.D., and Christina Williams, M.D. Division of Reproductive Endocrinology and Infertility, Department
More informationFemale fertility problems How Chinese medicine may help
Female fertility problems How Chinese medicine may help Prevalence of fertility problems According to figures issued by the Human Fertility and Embryology Authority (HFEA) in 2006, between 1 in 6 or 7
More informationAssociation of endometriosis and spontaneous abortion: effect of control group selection
FERTILITY AND STERILITY Copyright 1986 The American Fertility Society Vol. 45, No.1, January 1986 Printed in U.S A. Association of endometriosis and spontaneous abortion: effect of control group selection
More informationDirector of Commissioning, Telford and Wrekin CCG and Shropshire CCG. Version No. Approval Date August 2015 Review Date August 2017
Commissioning Policy for In Vitro Fertilisation (IVF)/ Intracytoplasmic Sperm Injection (ICSI) within tertiary Infertility Services, in Shropshire and Telford and Wrekin Owner(s) Version No. Director of
More informationORIGINAL ARTICLE ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES
ENDOMETRIAL THICKNESS AND PREGNANCY OUTCOME IN IUI CYCLES Asha Verma 1, Rekha Mulchandani 2, Nupur Lauria 3, Kusum Verma 4, Sunita Himani 5 HOW TO CITE THIS ARTICLE: Asha Verma, Rekha Mulchandani, Nupur
More informationInformation Booklet. Exploring the causes of infertility and treatment options.
Information Booklet Exploring the causes of infertility and treatment options www.ptafertility.co.za info@ptafertility.co.za +27 12 998 8854 Faith is taking the first step even if you don t see the whole
More informationEVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018
EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018 The evaluation of an infertile couple requires an understanding of
More informationAMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE INFERTILITY: AN OVERVIEW A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the
More informationInfertility. Thomas Lloyd and Samera Dean
Infertility Thomas Lloyd and Samera Dean Infertility Definition Causes Referral criteria Assisted reproductive techniques Complications Ethics What is infertility? Woman Reproductive age Has not conceived
More informationRisk factors for spontaneous abortion in menotropintreated
FERTILITY AND STERILITY Copyright ~ 1987 The American Fertility Society Vol. 48, No. 4, October 1987 Printed in U.S.A. Risk factors for spontaneous abortion in menotropintreated women Michael Bohrer, M.D.*
More informationPelvic Factor Infertility: Diagnosis and Prognosis of Various Procedures
Pelvic Factor Infertility: Diagnosis and Prognosis of Various Procedures CARLO BULLETTI, a I. PANZINI, b A. BORINI, c E. COCCIA, d PAOLO LEVI SETTI e AND ANTONIO PALAGIANO f a Physiopathology of Reproduction,
More informationClinical evaluation of infertility
Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST Definition: inability to achieve conception despite one year of frequent unprotected intercourse. Male
More informationSaudi Journal of Medicine (SJM)
Saudi Journal of Medicine (SJM) Scholars Middle East Publishers Dubai, United Arab Emirates Website: http://scholarsmepub.com/ ISSN 2518-3389 (Print) ISSN 2518-3397 (Online) Factors Affecting Outcomes
More informationWomen with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium*
FERTILITY AND STERILITY Copyright ~ 1991 The American Fertility Society Printed on acid-free paper in U.S.A. Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity
More informationUnexplained Infertility
Unexplained Infertility Kaylen M. Silverberg, M.D. Thomas C. Vaughn, M.D. Texas Fertility Center Austin, Texas Introduction Infertility is generally defined as the inability to conceive following one year
More informationSTRUCTURE AND FUNCTION OF THE FALLOPIAN TUBES FOLLOWING EXPOSURE TO DIETHYLSTILBESTROL (DES) DURING GESTATION*
FERTILITY AND STERILITY Copyright c 1981 The American Fertility Society Vol. 36, No. 6, December 1981 PrinU!d in U.SA. STRUCTURE AND FUNCTION OF THE FALLOPIAN TUBES FOLLOWING EXPOSURE TO DIETHYLSTILBESTROL
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal myomectomy in leiomyoma management, 77 Abnormal uterine bleeding (AUB) described, 103 105 normal menstrual bleeding vs., 104
More informationFertility Assessment and Treatment Pathway
Rejected referrals sent back to GP Fertility Assessment and Treatment Pathway Patients with fertility problems go to the GP GP Advice and Assessment GP to inform patient of access criteria for NHS-funded
More informationSelected risk factors of infertility in women: case control study
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Mallikarjuna M et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1714-1719 www.ijrcog.org pissn 2320-1770 eissn
More informationKey Words: Postoperative adhesions, surgical barriers, expanded polytetrafiuoroethylene, oxidized regenerated cellulose
FERTILITY AND STERILITY Copyright @ 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Expanded polytetrafluoroethylene (Gore-lex Surgical Membrane*) is superior to
More informationBleeding and spontaneous abortion after therapy for infertility
FERTILITY AND STERILITY VOL. 74, NO. 3, SEPTEMBER 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Bleeding and spontaneous
More informationEthicon Women s Health & Urology eclinical Compendium Article Summary
Ethicon Women s Health & Urology eclinical Compendium Article Summary Title Postoperative Adhesion Prevention With an Oxidized Regenerated Cellulose Adhesion Barrier in Infertile Women Author(s) Sawada
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationMiscellaneous deviations from normal anatomy resulting from embryologic maldevelopment of
Classification of fem male s genital tract malform mations 1 st Grigoris F. Grimbizis Ass. Pro ofessor st Dept of Obstetri ics & Gynecology Aristotle University of Thessaloniki Congenital Malformations
More information