Roy Homburg

Roy Homburg
Homerton University Hospital NHS Foundation Trust · Homerton Fertility Centre

MB,BS. FRCOG

Publications

Publications (321)
Chapter
Polycystic ovary syndrome (PCOS) is one of the most common reproductive health problems of women, causing irregular periods and potential infertility amongst other challenging symptoms. Effective treatment remains a significant challenge and is largely achieved through hormonal medication and lifestyle changes. This third edition covers the aetiolo...
Article
Advances in cancer treatment with resultant dramatic improvements in long-term survival have led to increasing awareness of the wide range of medical and social issues faced by survivors of malignancy. The potential deleterious effects on fertility are a significant worry of women and trans gender men, and the rising trend in delaying childbearing...
Article
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Consider This: We followed the paper (1) with interest stating that 3 cycles of IUI would result in a similar probability of live birth as 1 cycle of IVF (26.3% vs. 27.3%), but with lower risks of multiple birth, preterm infants, NICU admission, and gestational diabetes. The results were similar in women with infertility of unspecified origin and i...
Article
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Objectives The relationship between smoking and ovarian reserve markers is inconclusive. The primary objective of our study was to assess the effect of cigarette smoking on the quantitative ovarian reserve parameters, serum anti-Mullerian hormone (AMH) and antral follicle count (AFC) as relevant to prediction of fertility outcomes in women seeking...
Article
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The global increase in subfertility diagnosis and treatments and the rise of private equity investors concentrating on high profits based on in vitro fertilisation (IVF) treatments raise profound societal and economic questions for stakeholders and patients. The question remains as to whose benefits will ultimately be greater when promoting high ma...
Article
The treatment of a condition with no known cause such as unexplained infertility is unsurprisingly controversial. The alternatives that have been suggested for the first-line treatment are expectant management, ovarian stimulation, intra-uterine insemination (IUI) with or without ovarian stimulation or IVF. As far as live births are concerned, the...
Presentation
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Studies indicate that the optimal and safe number of oocytes needed for achieving an ongoing pregnancy is between six and 15. However, the use of egg freezing, frozen embryo replacement (FER) cycles and aggressive stimulation regimes has increased this number in order to boost success rates in older women and in poor responders who produce fewer eg...
Article
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Study question Are IVF clinics collecting too many oocytes per retrieval procedure? Summary answer IVF cycles performed in the UK appear to be retrieving far too many oocytes, most of which may never be used and are probably discarded. What is known already For justifying IVF with low AMH, older women, poor responders, the Bologna and POSEIDON co...
Article
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Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question el...
Article
Recent years have seen a dramatic rise in the number of frozen–thawed embryo replacement (FER) cycles. Along with the advances in embryo cryopreservation techniques, the optimization of endometrial receptivity has resulted in outcomes for FER that are similar to fresh embryo transfer. However, the question of whether the Freeze all strategy is for...
Article
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Research question: Is there vertical transmission (from mother to baby antenatally or intrapartum) after SARS-CoV-2 (COVID-19) infected pregnancy? Study design: A systematic search related to SARS-CoV-2 (COVID-19), pregnancy, neonatal complications, viral and vertical transmission. The duration was from December 2019 to May 2020. Results: A to...
Article
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Introduction This review covers the current evidence regarding the use of metformin as a therapeutic intervention for optimizing pregnancy outcomes in women with polycystic ovary syndrome (PCOS). Areas covered After searching Medline, Embase and CINAHL, all important large clinical trials and observational studies plus systematic reviews, meta-ana...
Article
Letter: Cost-effectiveness analyses in ART consumerism require transparency, simplicity and reproducibility , Sir, We welcome the focus on cost effectiveness analyses in assisted reproduction and in particular unravelling the most cost-effective mode for unexplained subfertility in females aged below 38 years, over a period of 3 years (van Eekelen...
Article
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Information supporting IVF at the expense of intra-uterine insemination (IUI) has become commonplace, but it lacks critical analyses. Data from poorly practiced IUI, without an equivalent comparison to IVF, has been gener-alised to recommend a total abandonment of IUI in favour of IVF treatment. Our intention with this paper is to reap-praise and b...
Article
Background: There is a lack of agreement among fertility specialists with regard to the routine use of mock embryo transfer (MET) before each in vitro fertilization (IVF) treatment cycle. While MET may be beneficial with previous difficult embryo transfer cases, its routine use before first IVF cycle has not been evaluated. Objective: To find ou...
Article
Full-text available
Information supporting IVF at the expense of intra-uterine insemination (IUI) has become commonplace, but it lacks critical analyses. Data from poorly practiced IUI, without an equivalent comparison to IVF, has been gener-alised to recommend a total abandonment of IUI in favour of IVF treatment. Our intention with this paper is to reap-praise and b...
Chapter
This chapter analyses the evidence-based clinical practices that are associated with better outcomes following intrauterine insemination (IUI). Innovative and successful approaches to IUI will be evaluated, with an overall aim of proposing how to improve IUI pregnancy rates. One strategy that seems to offer the highest chance of success, without co...
Article
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Despite an abundance of case reports and much heterogeneity, a new systematic review of 80 publications and a total of 846 COVID-19 positive pregnant women plus 688 babies born to infected mothers suggests that vertical transmission is possible. The much anticipated Tuesday session on COVID-19 heard Gulam Bahadur from London present details of a sy...
Article
Full-text available
The global severe acute respiratory syndrome-related coronavirus SARS-CoV-2 (COVID-19) pandemic has had an unprecedented impact on all aspects of daily life and healthcare. Information on the infection risks for pregnant women and their offspring have so far been limited to small case series, until a large UK report on 427 SARS- CoV-2 infected preg...
Article
Full-text available
The global severe acute respiratory syndrome-related coronavirus SARS-CoV-2 (COVID-19) pandemic has had an unprecedented impact on all aspects of daily life and healthcare. Information on the infection risks for pregnant women and their offspring have so far been limited to small case series, until a large UK report on 427 SARS-CoV-2 infected pregn...
Conference Paper
Full-text available
Despite an abundance of case reports and much heterogeneity, a new systematic review of 80 publications and a total of 846 COVID-19 positive pregnant women plus 688 babies born to infected mothers suggests that vertical transmission is possible. The much anticipated Tuesday session on COVID-19 heard Gulam Bahadur from London present details of a sy...
Article
Objective and Methods: All women seen at the Homerton Fertility Center, London (Site 1, n = 1787) and Hewitt Fertility Center, Liverpool (Site 2, n = 1258) in 15 months had serum AMH measured using the Access 2 fully automated benchtop immunoassay analyzer(Beckman Coulter Inc,) and a subset (n = 2031) were followed up to determine eggs collected an...
Article
The question on whether SARS-CoV-2 (Severe acute respiratory syndrome-related coronavirus (SARS-CoV or SARS-CoV-2, Covid-19) can be harboured in testes and/or the semen is currently unanswered. It is essential to understand the limitations of both antibody and real time polymerase chain reaction (RT-PCR) tests in interpreting SARS-CoV-2 data in rel...
Article
Full-text available
Objective To compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF). Design Retrospective observational study. Setting The UK from 2012 to 2016. Participants Data from Human Fertilisation and Embryology Authority’s freedom of information request for 2012–2016 for IV...
Article
Background: Polycystic ovary syndrome (PCOS) is the most frequent cause of anovulatory infertility. In women with PCOS, effective ovulation induction serves as an important first-line treatment for anovulatory infertility. Individual participant data (IPD) meta-analysis is considered as the gold standard for evidence synthesis which provides accur...
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The source of polycystic ovarian syndrome (PCOS) is much debated and is likely to be multifactorial. There is an apparent familial inheritance with first-degree relatives of sufferers more likely to be affected. Twin studies have suggested a genetic cause but candidate genes are yet to be verified. Genes affecting insulin resistance, steroid hormon...
Article
Objective: To study the effects of increasingly prosperous diet content on clinical features of polycystic ovary syndrome (PCOS). Design: A cross-sectional cohort study of 711 women with PCOS from a heterogeneous population spanning a wide spectrum of socioeconomic strata. Setting: Independent hospital. Patient(s): A total of 711 women with...
Article
Introduction: High levels of anti-Mullerian hormone and a high antral follicle count in women with polycystic ovary syndrome, reflecting increased ovarian antral follicles, predisposes them to have a high number of retrieved oocytes with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and an increased risk of ovarian hyperstim...
Article
Introduction: Certain medical disorders as well as their management may affect gonadal function. Recent advances in the management of these conditions accompanied by the availability and success of methods of fertility preservation has highlighted the need for assessment of ovarian reserve in childhood and adolescence. Serum anti-Mullerian hormone...
Article
IUI has been practiced for five decades but only three unconvincing trials attempted to demonstrate the superiority of IUI over sexual intercourse (SI). In the absence of evidence of its effectiveness, the National Institute for Clinical Excellence (NICE) recommended IVF over IUI after 2 years of unprotected SI. High-quality recent data in well-con...
Article
Religious teachings encourage fertility. The rapid progress of reproductive science has proved a challenge to interpret and adapt to assisted reproductive techniques which were not even dreamed of in ancient scriptures. The clash between religion and science has produced separate laws for each religion and reproductive practitioners are often at a...
Article
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Purpose: Serum anti-Mullerian hormone shows a strong positive correlation to the quantitative ovarian reserve but its correlation to embryo quality is unclear. This study assessed the association between serum AMH as a marker of ovarian reserve and embryo quality, using the technology of time-lapse imaging of the embryos in women undergoing in vit...
Article
Background: Most reviews of IVF ovarian stimulation protocols have insufficiently accounted for various patient populations, such as ovulatory women, women with polycystic ovary syndrome (PCOS) or women with poor ovarian response, and have included studies in which the agonist or antagonist was not the only variable between the compared study arms...
Article
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Background Polycystic ovary syndrome (PCOS), whose aetiology is unknown, is predominately a familial syndrome but confirmation of candidate genes has proved elusive. The developmental hypothesis for the origin of PCOS suggests that exposure of the fetus to excess androgens influences imprinting, leading to altered genetic expression in adult life....
Article
Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women. The pathophysiology of this syndrome is still not completely understood but recent evidence suggests that the intra-uterine environment may be a key factor in the pathogenesis of PCOS, in particular, hyperexposure of the foetus to andr...
Article
Full-text available
In a fertility industry, worth over £500 million in the UK alone, IVF cumulative pregnancy rate presentation inflates the actual result from what would otherwise appear as poor success rates to laypersons, hospital administrators and funding agencies such as CCGs (1-3). To suggest such a model would help a patient individually misses the point, sin...
Article
Objective: To evaluate the best first line management option for the treatment of unexplained subfertility-controlled ovarian hyperstimulation (COH) with gonadotropins and IUI or IVF. Design: Randomized controlled trial. Setting: Single center trial in a tertiary referral unit. Patient(s): Couples with unexplained subfertility. Intervention...
Article
This observational study compares the ratio of serum anti-Mullerian hormone (AMH) to the total antral follicle count (AFC) (as a marker of AMH production per follicle) in the various phenotypes of women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM). Two hundred and sixty-two women were recruited. Women with...
Article
This retrospective, single site observational study aimed to delineate five abnormal embryonic developmental phenotypes, assessing their prevalence, development potential and suitability for inclusion in embryo selection models for IVF. In total, 15,819 embryos from 4559 treatment cycles cultured in EmbryoScope® incubators between January 2014 and...
Article
Time-lapse imaging (TLI) systems for embryo incubation, assessment and selection are a novel technology available to in vitro fertilization (IVF) clinics. However, there is uncertainty about their clinical and cost-effectiveness and insufficient good quality evidence to warrant their routine use. Despite this, enthusiastic commercial marketing and...
Article
Objective: To study the efficacy of six embryo-selection algorithms (ESAs) when applied to a large, exclusive set of known implantation embryos. Design: Retrospective, observational analysis. Setting: Fertility treatment center. Patient(s): Women undergoing a total of 884 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI...
Article
In a fertility industry, worth over £500 million in the UK alone, IVF cumulative pregnancy rate presentation inflates the actual result from what would otherwise appear as poor success rates to laypersons, hospital administrators and funding agencies such as CCGs (1-3). To suggest such a model would help a patient individually misses the point, sin...
Article
Non-evidence based fertility practices were important to highlight, but we disagree with the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). HFEA have no legal jurisdiction in providing clinical guidance while NICE have seriously failed to provide evidence for first line treatment options (2). T...
Article
We note the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). Although HFEA have no legal jurisdiction in providing guidance, NICE have failed to address several important points in the evidence review for first line treatment options (2). The original NICE document proposing that IVF should be of...
Article
NICE guidelines fail to provide evidence on first line fertility treatment, BMJOnline, December 2016 We note the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). Although HFEA have no legal jurisdiction in providing guidance, NICE have failed to address several important points in the evidence re...
Article
We note the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). Although HFEA have no legal jurisdiction in providing guidance, NICE have failed to address several important points in the evidence review for first line treatment options (2). The original NICE document proposing that IVF should be of...
Article
We note the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). Although HFEA have no legal jurisdiction in providing guidance, NICE have failed to address several important points in the evidence review for first line treatment options (2). The original NICE document proposing that IVF should be of...
Article
We note the recommendation that NICE together with HFEA should provide fertility guidance on what is offered (1). Although HFEA have no legal jurisdiction in providing guidance, NICE have failed to address several important points in the evidence review for first line treatment options (2). The original NICE document proposing that IVF should be of...
Article
A retrospective strict matched-pair analysis of 728 treatment cycles between January 2011 and September 2014 was performed. A total of 364 treatment cycles, where all embryos were cultured and examined in EmbryoScope®, were matched to treatment cycles where all the embryos were cultured in a standard incubator with conventional morphological examin...
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In the literature, there is growing evidence that subfertile patients who conceived after infertility treatments have an increased risk of pregnancy and perinatal complications and this is particularly true for patients who conceived through use of high technology infertility treatments. Moreover, high technology infertility treatments include many...
Article
Last year we and others protested against the National Institute for Health and Care Excellence (NICE) guideline (2013) for unexplained infertility, which recommended expectant treatment for up to two years, and then proceeding to IVF if this was unsuccessful, blatantly ruling out the possibility of using intra-uterine insemination (IUI) as a possi...
Article
Full-text available
Last year we and others protested against the National Institute for Health and Care Excellence (NICE) guideline (2013) for unexplained infertility, which recommended expectant treatment for up to two years, and then proceeding to IVF if this was unsuccessful, blatantly ruling out the possibility of using intra-uterine insemination (IUI) as a possi...
Article
Full-text available
Last year we and others protested against the National Institute for Health and Care Excellence (NICE) guideline (2013) for unexplained infertility, which recommended expectant treatment for up to two years, and then proceeding to IVF if this was unsuccessful, blatantly ruling out the possibility of using intra-uterine insemination (IUI) as a possi...
Article
Full-text available
This review addresses the misplaced facts about the IUI procedure within a lucrative fertility industry. Evidence suggests IUI must be a first-line treatment option for most couples except in cases of bilateral tubal blockage and severe oligozoospermia. We introduce the concept of using ‘consecutive ejaculation’ in men with subfertility and one whi...
Article
The advent of intracytoplasmic sperm injection (ICSI) has contributed to a significant growth in the delivery of assisted conception technique, such that IVF/ICSI procedures are now recommended over other interventions. Even the UK National Institute for Health Care Excellence (NICE) guidelines controversially recommends against intrauterine insemi...
Article
Anti-Müllerian hormone (AMH) is expressed by the granulosa cells of the pre-antral and small antral follicles in the ovary. It is significantly higher in women with polycystic ovary syndrome (PCOS) due to an increased number of antral follicles and also a higher production per antral follicle. It is postulated to have an inhibitory role in follicul...
Article
Unexplained subfertility is diagnosed when standard investigations (tests for ovulation, tubal patency and semen analysis) are all normal. Between 30% and 40% of subfertile couples fall into this category. In some couples, unexplained subfertility may result from subtle undetectable factors; in other couples, it may be associated with a genuine abs...
Article
Objective: Little is known about the aetiology of polycystic ovary syndrome (PCOS). Some suggest that elevated maternal androgens during gestation play a causative role. This implies placental passage of androgens during pregnancy. The aim of this study is to compare androgen and estrogen concentrations in maternal serum during pregnancy and in um...
Article
Full-text available
The National Institute for Health and Care Excellence (NICE) guideline (2013), when referring to unexplained infertility, recommends expectant treatment for up to two years and then, if unsuccessful, proceeding to IVF, blatantly ruling out the possibility of using intra-uterine insemination (IUI) as a possible intermediate treatment. In our hospita...
Article
Full-text available
The National Institute for Health and Care Excellence (NICE) guideline (2013), when referring to unexplained infertility, recommends expectant treatment for up to two years and then, if unsuccessful, proceeding to IVF, blatantly ruling out the possibility of using intra-uterine insemination (IUI) as a possible intermediate treatment. In our hospita...
Chapter
The use of gonadotropins in the treatment of unexplained infertility for women, who are apparently ovulating regularly, appears logically to be a futile exercise. However, whether by correcting subtle deficiencies in the ovulation process, improving the endocrine environment, and/or endometrial receptivity, ovarian stimulation with gonadotropins pr...
Article
Key contentFertility preservation is a rapidly evolving branch of reproductive medicine.Ovarian senescence, whether physiological or pathologically accelerated, limits the reproductive capacity of women.Given the increasing numbers of young women surviving cancer, along with increasing numbers of women deferring childbearing for social reasons, the...
Article
To ascertain if subfertile women with polycystic ovary syndrome (PCOS) secrete more antimüllerian hormone (AMH) per antral follicle than control women. Observational cross-sectional study. Fertility clinic. A total of 438 women attending the fertility clinic over a period of 13 months from September 2012 to September 2013. Serum concentrations of A...
Article
BACKGROUND There is a growing body of evidence surrounding the role played by seminal plasma in human implantation. Seminal fluid contains several proteins that interact with cervical and uterine epithelial cells inducing active immune tolerance. We sought to answer the study question: Does exposure to seminal plasma improve pregnancy outcomes in w...
Article
Objective To assess whether ethnic differences in serum anti-Mullerian hormone (AMH) exist in a population of subfertile women presenting to a fertility clinic.DesignObservational cross-sectional study.SettingHomerton University Hospital Fertility Centre, London, UK.PopulationA total of 865 women attending the fertility clinic for their first consu...
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STUDY QUESTION Which reproductive endocrine changes are attributed exclusively to laparoscopic ovarian drilling in polycystic ovarian syndrome (PCOS)?
Article
The recent National Institute for Health and Care Excellence (NICE) guideline on Fertility (2012) suggests that IVF should be offered to couples with unexplained subfertility after 2 years of expectant management. The evidence on which these recommendations are based is not robust and there is a lack of agreement among specialists regarding the man...
Article
Women's choice to delay fertility due to various reasons is making subfertility a growing problem and increased use of IVF as a last resort. Despite advances in the technology, IVF success remains low, especially in older women. Hence, many of these women need to undergo several cycles of IVF and are faced with unprecedented anxiety and frustration...
Article
Full-text available
Polycystic ovary syndrome (PCOS) is the most common cause of infertility due to anovulation. Despite its prevalence, the precise cause of the anovulation is yet to be clearly defined. There is an increased number of pre-antral and antral follicles in the polycystic ovary, many of which individually produce increased amounts of anti-Müllerian hormon...
Chapter
Since the early 1960s we have been privileged to witness one of the most amazing evolutions in modern medical practice, that of infertility treatment. Up to that time we could do little to help the infertile couple and a consultation usually consisted of some wise nodding of the head and an explanation of the frequency and timing of intercourse. Th...
Chapter
The release of a mature, fertilizable egg from the dominant follicle is the culmination of a wonderfully integrated and synchronized succession of hormonal actions and morphological changes involving the hypothalamus, pituitary and ovaries. The major players in this system are gonadotrophin releasing-hormone (GnRH), FSH, LH, oestrogen and progester...
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The prevention of ovarian hyperstimulation syndrome (OHSS) should be of paramount importance as it is by far the most serious complication of both ovulation induction and IVF. OHSS is an iatrogenic condition caused by overdosing with gonadotrophin stimulation and is therefore almost totally preventable. High responders to gonadotrophin stimulation...
Chapter
Excessive prolactin secretion is a not infrequent cause of anovulation and consequent infertility, often associated with amenorrhea or oligomenorrhea. Only hyperprolactinaemia causing ovulatory disturbance deserves treatment. Clinically, galactorrhea may be a sign of hyperprolactinaemia but galactorrhea may often occur without associated hyperprola...
Chapter
Polycystic ovary syndrome (PCOS) is associated with about 75 % of all cases of anovulatory infertility. Insulin resistance is frequently associated with PCOS, occurring in 80 % of women with PCOS and central obesity, but also in 30–40 % of lean women with PCOS. As a result of the reduction in insulin sensitivity, hyperinsulinaemia is invoked as a c...
Chapter
Gonadotrophin therapy is a highly successful way of inducing ovulation and pregnancy for women who have anovulation associated with PCOS who have failed to conceive with anti-oestrogens. The complications of gonadotrophin therapy are multiple pregnancies and ovarian hyperstimulation syndrome (OHSS), both almost entirely dependent on a large number...
Chapter
Few problems in IVF are more frustrating than the poor responder to gonadotrophin stimulation, most commonly seen in advanced fertile age but also after ovarian surgery, advanced endometriosis, endometriomas, obesity, previous pelvic infection/adhesions, smoking, post chemotherapy/radiotherapy. Many definitions have been proposed but the most widel...
Chapter
The original treatment for PCOS, proposed by Stein and Levanthal in 1935, was bilateral wedge resection of the ovaries. This met with remarkable success regarding resumption of ovulation but was abandoned due to the high probability of inducing pelvic adhesions and the advent of medical means of inducing ovulation. Today the same effect of decreasi...
Chapter
The history and examination alone will often point toward the diagnosis and dictate the order in which examinations should be performed. Using this approach and good common sense, laboratory examinations, expense and time can be limited to a minimum. There are four major categories of causes of anovulation: hypothalamic-pituitary failure, hypothala...
Chapter
Hypogonadotrophic-hypogonadism (hypothalamic-pituitary failure -WHO Group I), is a situation in which gonadotrophin concentrations are so low as to be completely unable to stimulate follicle development and oestrogen production from the ovaries. Anovulation, amenorrhea and hypo-oestrogenism are the consequences. There are several possible causes fo...
Chapter
For many years the principle adopted was that the greater the number of eggs retrieved, the greater the chance of a pregnancy. To achieve this aim, large doses of gonadotrophins are used, most commonly with a long GnRH agonist protocol. This regimen is long, expensive, requiring high gonadotrophin dosage and frequent monitoring and pre-disposes to...
Chapter
Before any treatment for infertility, some important factors affecting the outcome of this treatment must be taken i