Skip to main content
Top
Published in: Journal of Ovarian Research 1/2014

Open Access 01-12-2014 | Research

Impaired uterine artery flow associated with the presence of ovarian endometrioma: preliminary results of a prospective study

Authors: Maria Grazia Porpora, Federica Tomao, Lucia Manganaro, Deliar Yazdanian, Eliana Fuggetta, Maria Grazia Piccioni, Pierluigi Benedetti Panici, Giuseppe Benagiano

Published in: Journal of Ovarian Research | Issue 1/2014

Login to get access

Abstract

Background

Aim of this prospective, case–control study was to evaluate uterine arteries’ blood flow before and after laparoscopic surgery in patients with ovarian endometriosis and its possible correlation with infertility.

Methods

We prospectively enrolled 110 women of reproductive age; 69 with ovarian endometriomas and scheduled for surgery, and 41 controls. At enrolment, a detailed medical, gynecologic and obstetric history was collected. Fertility and pregnancy desire were assessed. All patients underwent complete physical and gynecologic examination. Transvaginal ultrasound with Doppler color flow was performed to evaluate Resistance Index (RI) of uterine arteries during the secretory phase, at enrolment (T0) and 3 months after laparoscopic surgery (T1).

Results

Among cases, 27 patients were excluded because they did not meet the inclusion criteria. At enrolment (T0) unilateral or bilateral flow alterations (RI ≥ 0.8) were found in 38 out of 42 patients with ovarian endometriosis (90%), whereas in the control group only 17 women (41%) had Doppler alterations. The difference in uterine artery RI values between cases and controls was statistically significant (P < 0.0001). A statistically significant improvement in uterine artery flow (P <0.0001) was found 3 months after surgical treatment of endometriosis. Nineteen patients with endometriosis (45%) were infertile before surgery; all of them presented uterine artery Doppler alterations at T0. After surgery the pregnancy rate was significantly higher in patients who presented uterine artery flow normalization than in those with persistent uterine artery flow alterations (p = 0.002).

Conclusions

A strong correlation was found between uterine artery flow abnormalities and ovarian endometriosis. Uterine artery flow improvement following surgery seems to increase the probabilities of achieving pregnancy.
Appendix
Available only for authorised users
Literature
1.
go back to reference Petraglia F, Arcuri F, de Ziegler D, Chapron C: Inflammation: a link between endometriosis and preterm birth. Fertil Steril 2012,98(1):36–40. 10.1016/j.fertnstert.2012.04.051CrossRefPubMed Petraglia F, Arcuri F, de Ziegler D, Chapron C: Inflammation: a link between endometriosis and preterm birth. Fertil Steril 2012,98(1):36–40. 10.1016/j.fertnstert.2012.04.051CrossRefPubMed
2.
go back to reference Practice Committee of the American Society for Reproductive Medicine: Endometriosis and infertility: a committee opinion. Fertil Steril 2012,98(3):591–598.CrossRef Practice Committee of the American Society for Reproductive Medicine: Endometriosis and infertility: a committee opinion. Fertil Steril 2012,98(3):591–598.CrossRef
3.
go back to reference Rogers PA, D’Hooghe TM, Fazleabas A, Giudice LC, Montgomery GW, Petraglia F, Taylor RN: Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis In Montpellier, France. Reprod Sci 2013,20(5):483–499. 10.1177/1933719113477495PubMedCentralCrossRefPubMed Rogers PA, D’Hooghe TM, Fazleabas A, Giudice LC, Montgomery GW, Petraglia F, Taylor RN: Defining future directions for endometriosis research: workshop report from the 2011 World Congress of Endometriosis In Montpellier, France. Reprod Sci 2013,20(5):483–499. 10.1177/1933719113477495PubMedCentralCrossRefPubMed
4.
go back to reference de Ziegler D, Borghese B, Chapron C: Endometriosis and infertility: pathophysiology and management. Lancet 2010,376(9742):730–738. 10.1016/S0140-6736(10)60490-4CrossRefPubMed de Ziegler D, Borghese B, Chapron C: Endometriosis and infertility: pathophysiology and management. Lancet 2010,376(9742):730–738. 10.1016/S0140-6736(10)60490-4CrossRefPubMed
5.
go back to reference Macer ML, Taylor HS: Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin N Am 2012,39(4):535–549. 10.1016/j.ogc.2012.10.002CrossRef Macer ML, Taylor HS: Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin N Am 2012,39(4):535–549. 10.1016/j.ogc.2012.10.002CrossRef
6.
go back to reference Carvalho LFP, Rossener R, Azeem A, Malvezzi H, Simões Abrão M, Agarwal A: From conception to birth: how endometriosis affects the development of each stage of reproductive life. Minerva Ginecol 2013,65(2):181–198.PubMed Carvalho LFP, Rossener R, Azeem A, Malvezzi H, Simões Abrão M, Agarwal A: From conception to birth: how endometriosis affects the development of each stage of reproductive life. Minerva Ginecol 2013,65(2):181–198.PubMed
7.
go back to reference Brosens I, Gordts S, Benagiano G: Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 2013,28(8):2026–2031. 10.1093/humrep/det243PubMedCentralCrossRefPubMed Brosens I, Gordts S, Benagiano G: Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 2013,28(8):2026–2031. 10.1093/humrep/det243PubMedCentralCrossRefPubMed
8.
go back to reference Loh FH, Tan AT, Kumar J, Ng SC: Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 1999,72(2):316–321. 10.1016/S0015-0282(99)00207-1CrossRefPubMed Loh FH, Tan AT, Kumar J, Ng SC: Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 1999,72(2):316–321. 10.1016/S0015-0282(99)00207-1CrossRefPubMed
9.
go back to reference Horikawa T, Nakagawa K, Ohgi S, Kojima R, Nakashima A, Ito M, et al.: The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet 2008,25(6):239–244. 10.1007/s10815-008-9229-yPubMedCentralCrossRefPubMed Horikawa T, Nakagawa K, Ohgi S, Kojima R, Nakashima A, Ito M, et al.: The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet 2008,25(6):239–244. 10.1007/s10815-008-9229-yPubMedCentralCrossRefPubMed
10.
go back to reference Shah DK: Diminished ovarian reserve and endometriosis: insult upon injury. Semin Reprod Med 2013,31(2):144–149.CrossRefPubMed Shah DK: Diminished ovarian reserve and endometriosis: insult upon injury. Semin Reprod Med 2013,31(2):144–149.CrossRefPubMed
11.
go back to reference Tinkanen H, Kujansuu E: In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand 2000,79(2):119–122. 10.1034/j.1600-0412.2000.079002119.xCrossRefPubMed Tinkanen H, Kujansuu E: In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand 2000,79(2):119–122. 10.1034/j.1600-0412.2000.079002119.xCrossRefPubMed
12.
go back to reference Donnez J, Wyns C, Nisolle M: Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril 2001,76(4):662–665. 10.1016/S0015-0282(01)02011-8CrossRefPubMed Donnez J, Wyns C, Nisolle M: Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril 2001,76(4):662–665. 10.1016/S0015-0282(01)02011-8CrossRefPubMed
13.
go back to reference Opøien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, Oldereid N, Mellembakken JR, Tanbo T: In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril 2012,97(4):912–918. 10.1016/j.fertnstert.2012.01.112CrossRefPubMed Opøien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, Oldereid N, Mellembakken JR, Tanbo T: In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril 2012,97(4):912–918. 10.1016/j.fertnstert.2012.01.112CrossRefPubMed
14.
go back to reference Demirol A, Guven S, Baykal C, Gurgan T: Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 2006,12(5):639–643. 10.1016/S1472-6483(10)61192-3CrossRefPubMed Demirol A, Guven S, Baykal C, Gurgan T: Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 2006,12(5):639–643. 10.1016/S1472-6483(10)61192-3CrossRefPubMed
15.
go back to reference Steer CV, Campbell S, Pampiglione JS, Kingsland CR, Mason BA, Collins WP: Transvaginal color flow imaging of the uterine arteries during the ovarian and menstrual cycles. Hum Reprod 1990,5(4):391–395.PubMed Steer CV, Campbell S, Pampiglione JS, Kingsland CR, Mason BA, Collins WP: Transvaginal color flow imaging of the uterine arteries during the ovarian and menstrual cycles. Hum Reprod 1990,5(4):391–395.PubMed
16.
go back to reference Steer CV, Tan SL, Mason BA, Campbell S: Midluteal-phase vaginal color Doppler assessment of uterine artery impedance in a subfertile population. Fertil Steril 1994,61(1):53–58.PubMed Steer CV, Tan SL, Mason BA, Campbell S: Midluteal-phase vaginal color Doppler assessment of uterine artery impedance in a subfertile population. Fertil Steril 1994,61(1):53–58.PubMed
17.
go back to reference Exacoustos C, Brienza L, Di Giovanni A, Szabolcs B, Romanini ME, Zupi E, et al.: Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol 2011,37(4):471–479. 10.1002/uog.8900CrossRefPubMed Exacoustos C, Brienza L, Di Giovanni A, Szabolcs B, Romanini ME, Zupi E, et al.: Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol 2011,37(4):471–479. 10.1002/uog.8900CrossRefPubMed
18.
go back to reference El-Mazny A, Abou-Salem N, Elshenoufy H: Doppler study of uterine hemodynamics in women with unexplained infertility. Eur J Obstet Gynecol Reprod Biol in press El-Mazny A, Abou-Salem N, Elshenoufy H: Doppler study of uterine hemodynamics in women with unexplained infertility. Eur J Obstet Gynecol Reprod Biol in press
19.
go back to reference Guerriero S, Ajossa S, Mais V, Risalvato A, Lai MP, Melis GB: The diagnosis of endometriomas using color Doppler energy imaging. Hum Reprod 1998,13(6):1691–1695. 10.1093/humrep/13.6.1691CrossRefPubMed Guerriero S, Ajossa S, Mais V, Risalvato A, Lai MP, Melis GB: The diagnosis of endometriomas using color Doppler energy imaging. Hum Reprod 1998,13(6):1691–1695. 10.1093/humrep/13.6.1691CrossRefPubMed
20.
go back to reference Joyce CR, Zutshi DW, Hrubes V, Mason RM: Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 1975,8(6):415–420. 10.1007/BF00562315CrossRefPubMed Joyce CR, Zutshi DW, Hrubes V, Mason RM: Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 1975,8(6):415–420. 10.1007/BF00562315CrossRefPubMed
21.
go back to reference Manganaro L, Fierro F, Tomei A, Irimia D, Lodise P, Sergi ME, et al.: Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 2012,81(6):1381–1387. 10.1016/j.ejrad.2011.03.049CrossRefPubMed Manganaro L, Fierro F, Tomei A, Irimia D, Lodise P, Sergi ME, et al.: Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 2012,81(6):1381–1387. 10.1016/j.ejrad.2011.03.049CrossRefPubMed
22.
go back to reference Manganaro L, Vittori G, Vinci V, Fierro F, Tomei A, Lodise P, Sollazzo P, et al.: Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 2012,30(10):1432–1438. 10.1016/j.mri.2012.05.006CrossRefPubMed Manganaro L, Vittori G, Vinci V, Fierro F, Tomei A, Lodise P, Sollazzo P, et al.: Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 2012,30(10):1432–1438. 10.1016/j.mri.2012.05.006CrossRefPubMed
23.
go back to reference Manganaro L, Vinci V, Bernardo S, Storelli P, Fuggetta E, Sollazzo P, et al.: The role of 3.0T MRI in the assessment of deep endometriosis located on the uterosacral ligaments. J Endom 2013,5(1):10–16. Manganaro L, Vinci V, Bernardo S, Storelli P, Fuggetta E, Sollazzo P, et al.: The role of 3.0T MRI in the assessment of deep endometriosis located on the uterosacral ligaments. J Endom 2013,5(1):10–16.
24.
go back to reference Kurjak A, Kupesic-Urek S, Schulman H, Zalud I: Transvaginal color flow Doppler in the assessment of ovarian and uterine blood flow in infertile women. Fertil Steril 1991,56(5):870–873.PubMed Kurjak A, Kupesic-Urek S, Schulman H, Zalud I: Transvaginal color flow Doppler in the assessment of ovarian and uterine blood flow in infertile women. Fertil Steril 1991,56(5):870–873.PubMed
25.
go back to reference Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E, ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group: ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005,20(10):2698–2704. 10.1093/humrep/dei135CrossRefPubMed Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E, ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group: ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005,20(10):2698–2704. 10.1093/humrep/dei135CrossRefPubMed
26.
go back to reference Porpora MG, Pallante D, Ferro A, Crisafi B, Bellati F, Benedetti Panici P: Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010,93(3):716–721. 10.1016/j.fertnstert.2008.10.018CrossRefPubMed Porpora MG, Pallante D, Ferro A, Crisafi B, Bellati F, Benedetti Panici P: Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010,93(3):716–721. 10.1016/j.fertnstert.2008.10.018CrossRefPubMed
27.
go back to reference Osuga Y, Koga K, Tsutsumi O, Yano T, Maruyama M, Kugu K, Momoeda M, Taketani Y: Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest 2002,53(Suppl 1):33–39.CrossRefPubMed Osuga Y, Koga K, Tsutsumi O, Yano T, Maruyama M, Kugu K, Momoeda M, Taketani Y: Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest 2002,53(Suppl 1):33–39.CrossRefPubMed
28.
go back to reference Porpora MG, Pultrone DC, Bellavia M, Franco C, Crobu M, Cosmi EV: Reproductive outcome after laparoscopic treatment of endometriosis. Clin Exp Obstet Gynecol 2002,29(4):271–273.PubMed Porpora MG, Pultrone DC, Bellavia M, Franco C, Crobu M, Cosmi EV: Reproductive outcome after laparoscopic treatment of endometriosis. Clin Exp Obstet Gynecol 2002,29(4):271–273.PubMed
29.
go back to reference Garcia-Velasco JA, Somigliana E: Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009,24(3):496–501.CrossRefPubMed Garcia-Velasco JA, Somigliana E: Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009,24(3):496–501.CrossRefPubMed
30.
go back to reference Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L: Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 2010,25(3):678–682. 10.1093/humrep/dep464CrossRefPubMed Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L: Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 2010,25(3):678–682. 10.1093/humrep/dep464CrossRefPubMed
31.
go back to reference Benaglia L, Pasin R, Somigliana E, Vercellini P, Ragni G, Fedele L: Unoperated ovarian endometriomas and responsiveness to hyperstimulation. Hum Reprod 2011,26(6):1356–1361. 10.1093/humrep/der097CrossRefPubMed Benaglia L, Pasin R, Somigliana E, Vercellini P, Ragni G, Fedele L: Unoperated ovarian endometriomas and responsiveness to hyperstimulation. Hum Reprod 2011,26(6):1356–1361. 10.1093/humrep/der097CrossRefPubMed
32.
go back to reference Almog B, Shehata F, Sheizaf B, Tan SL, Tulandi T: Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization. Fertil Steril 2011,95(2):525–527. 10.1016/j.fertnstert.2010.03.011CrossRefPubMed Almog B, Shehata F, Sheizaf B, Tan SL, Tulandi T: Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization. Fertil Steril 2011,95(2):525–527. 10.1016/j.fertnstert.2010.03.011CrossRefPubMed
33.
go back to reference Somigliana E, Vercellini P, Viganó P, Ragni G, Crosignani PG: Should endometriomas be treated before IVF-ICSI cycles? Hum Reprod Update 2006,12(1):57–64.CrossRefPubMed Somigliana E, Vercellini P, Viganó P, Ragni G, Crosignani PG: Should endometriomas be treated before IVF-ICSI cycles? Hum Reprod Update 2006,12(1):57–64.CrossRefPubMed
34.
go back to reference Benaglia L, Somigliana E, Iemmello R, Colpi E, Nicolosi AE, Ragni G: Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication? Fertil Steril 2008,89(5):1263–1266. 10.1016/j.fertnstert.2007.05.038CrossRefPubMed Benaglia L, Somigliana E, Iemmello R, Colpi E, Nicolosi AE, Ragni G: Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication? Fertil Steril 2008,89(5):1263–1266. 10.1016/j.fertnstert.2007.05.038CrossRefPubMed
35.
go back to reference Benaglia L, Somigliana E, Vighi V, Nicolosi AE, Iemmello R, Ragni G: Is the dimension of ovarian endometriomas significantly modified by IVF-ICSI cycles? Reprod Biomed Online 2009,18(3):401–406. 10.1016/S1472-6483(10)60099-5CrossRefPubMed Benaglia L, Somigliana E, Vighi V, Nicolosi AE, Iemmello R, Ragni G: Is the dimension of ovarian endometriomas significantly modified by IVF-ICSI cycles? Reprod Biomed Online 2009,18(3):401–406. 10.1016/S1472-6483(10)60099-5CrossRefPubMed
36.
go back to reference Nezhat C, Winer WK, Cooper JD, Nezhat F, Nezhat C: Endoscopic infertility surgery. J Reprod Med 1989,34(2):127–134.PubMed Nezhat C, Winer WK, Cooper JD, Nezhat F, Nezhat C: Endoscopic infertility surgery. J Reprod Med 1989,34(2):127–134.PubMed
37.
go back to reference Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG: Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 2006,21(10):2679–2685. 10.1093/humrep/del230CrossRefPubMed Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG: Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 2006,21(10):2679–2685. 10.1093/humrep/del230CrossRefPubMed
38.
go back to reference Hart RJ, Hickey M, Maouris P, Buckett W, Garry R: Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008., 2: CD004992 Hart RJ, Hickey M, Maouris P, Buckett W, Garry R: Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008., 2: CD004992
39.
go back to reference Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS, Johnson IR: Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility. Hum Reprod 2004, 19: 2605–2614. 10.1093/humrep/deh459CrossRefPubMed Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS, Johnson IR: Endometrial and subendometrial perfusion are impaired in women with unexplained subfertility. Hum Reprod 2004, 19: 2605–2614. 10.1093/humrep/deh459CrossRefPubMed
40.
go back to reference Maneschi F, Marasá L, Incandela S, Mazzarese M, Zupi E: Ovarian cortex surrounding benign neoplasms: a histologic study. Am J Obstet Gynecol 1993,169(2 Pt 1):388–393.CrossRefPubMed Maneschi F, Marasá L, Incandela S, Mazzarese M, Zupi E: Ovarian cortex surrounding benign neoplasms: a histologic study. Am J Obstet Gynecol 1993,169(2 Pt 1):388–393.CrossRefPubMed
41.
go back to reference Santoro L, D’Onofrio F, Campo S, Ferraro PM, Tondi P, Campo V, Flex A, Gasbarrini A, Santoliquido A: Endothelial dysfunction but not increased carotid intima-media thickness in young European women with endometriosis. Hum Reprod 2012,27(5):1320–1326. 10.1093/humrep/des062CrossRefPubMed Santoro L, D’Onofrio F, Campo S, Ferraro PM, Tondi P, Campo V, Flex A, Gasbarrini A, Santoliquido A: Endothelial dysfunction but not increased carotid intima-media thickness in young European women with endometriosis. Hum Reprod 2012,27(5):1320–1326. 10.1093/humrep/des062CrossRefPubMed
Metadata
Title
Impaired uterine artery flow associated with the presence of ovarian endometrioma: preliminary results of a prospective study
Authors
Maria Grazia Porpora
Federica Tomao
Lucia Manganaro
Deliar Yazdanian
Eliana Fuggetta
Maria Grazia Piccioni
Pierluigi Benedetti Panici
Giuseppe Benagiano
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Ovarian Research / Issue 1/2014
Electronic ISSN: 1757-2215
DOI
https://doi.org/10.1186/1757-2215-7-1

Other articles of this Issue 1/2014

Journal of Ovarian Research 1/2014 Go to the issue