Ioannis Papadimas

Aristotle University of Thessaloniki, Saloníki, Central Macedonia, Greece

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Publications (22)69.31 Total impact

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    ABSTRACT: Abstract We have previously hypothesized that early miscarriage in women with Hashimoto thyroiditis might be the result of a cross-reactivity process, in which blocking autoantibodies against thyrotropin receptor (TSHr-Ab) antagonize hCG action on its receptor on the corpus luteum. To test this hypothesis from the clinical perspective, we investigated the presence of TSHr-Ab in Hashimoto thyroiditis patients with apparently unexplained, first-trimester recurrent miscarriages compared to that in Hashimoto thyroiditis patients with documented normal fertility. A total of 86 subjects (43 cases and 43 age-matched controls) were finally included in a case-control study. No difference in the prevalence of TSHr-Ab positivity was detected between cases and controls (Fisher's exact test, p value = 1.00). In patients with recurrent miscarriages, TSHr-Ab concentrations did not predict the number of miscarriages (univariate linear regression, p value = 0.08). These results were robust in sensitivity analyses, including only cases with full investigation or those with three or more miscarriages. We conclude that no role could be advocated for TSHr-Ab in the aetiology of recurrent miscarriages in women with Hashimoto thyroiditis.
    No preview · Article · Jun 2013 · Gynecological Endocrinology
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    ABSTRACT: To perform a highly detailed semen analysis in a man whose wife had a partial mole. Case report. Gynecology departments of two university hospitals and a laboratory of histology/embryology. A 32-year-old man whose wife had a partial mole. Sperm characteristics were examined by light microscopy, morphology was analysed by electron microscopy (TEM), DNA fragmentation was evaluated by TUNEL using fluorescence microscopy, and chromosomal abnormalities were assessed by fluorescence in situ hybridization using probes for chromosomes 13, 15, 16, 18, 21, 22, X, and Y. Sperm count, motility, morphology, DNA fragmentation, and incidence of diploidy, tetraploidy, and aneuploidy. Sperm concentration was 61 million/mL, with 31% progressive motility and 4% normal morphology. TEM revealed a high incidence of head, neck, and tail abnormalities as well as the presence of phagocytes. DNA fragmentation was within normal limits (11.6%). Aneuploidy levels were low for all chromosomes tested. However, there was a high level of diploidy, with XY, XX, and YY constitution. Tetraploid sperm (XXYY) were also noted. Semen analysis revealed a high incidence of abnormal morphology and increased diploidy. It may be important to perform FISH testing, to verify increased diploidy in sperm, in men whose wives have had partial moles. These couples could be informed of the option to have preimplantation genetic diagnosis as a means to distinguish between diploid and triploid embryos arising from fertilization of a haploid egg by diploid sperm.
    No preview · Article · Feb 2011 · Fertility and sterility
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    ABSTRACT: Introduction: The pathophysiology of subfertility in men with varicocele remains unclear as well as the role of inhibin B (Inh-B) and anti-Müllerian hormone (AMH). The aim of this study was to evaluate Inh-B and AMH concentrations in the spermatic vein of subfertile men with varicocele. Patients and Methods: A total of 61 subfertile men with varicocele and 31 fertile controls underwent standard andrological evaluation. All subfertile men underwent varicocelectomy, during which blood samples were obtained from the spermatic vein to evaluate Inh-B and AMH concentrations. Results: Peripheral vein Inh-B concentrations in men with varicocele were lower as compared to controls (52.9 [8.3-136.0) vs 116±9.7 ng/dL, P = .001). There was no difference in AMH concentrations (10.2 [4.4-45.4]) vs 10.4±0.8 pg/dL, P = 0.9). Spermatic vein Inh-B concentrations in men with varicocele were higher compared to those of peripheral vein (87.6±4.4 vs 52.9 [8.3-136.0] ng/dL, P = .001). On the contrary, spermatic vein AMH concentrations were lower compared to those from peripheral vein (8.84 [3.9-47.7] vs 10.2 [4.4-45.4] pg/dL, P = .013). Conclusions: Inh-B constitutes a reliable marker of Sertoli cell function as well as spermatogenesis. On the contrary, the clinical significance of AMH in men with varicocele remains to be elucidated.
    No preview · Article · Feb 2011 · Reproductive sciences (Thousand Oaks, Calif.)
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    ABSTRACT: The clinical and laboratory features as well as the diagnostic and therapeutic approach of men with XYY syndrome have not been fully described. A 41-year-old infertile man was diagnosed as having a 47,XYY karyotype and a micro-prolactinoma. His 32-year-old wife had a history of five spontaneous pregnancies, all resulting in first trimester miscarriages. Three in-vitro fertilization (IVF) attempts were made with no biochemical pregnancy. During the third attempt, a pre-implantation genetic diagnosis (PGD) was performed by fluorescent in-situ hybridization (FISH) technique. Only one out of six (16%) embryos had normal karyotype. Conclusions: (1) Karyotypic analysis of both partners is a sine qua non investigation for recurrent miscarriages; (2) the XYY syndrome results in high frequency of embryo aneuploidy; (3) PGD by FISH can contribute to the transferring of chromosomally normal embryos in cases of parental chromosomal defects; (4) investigation for a prolactinoma should be considered in men with XYY syndrome.
    No preview · Article · Jan 2011 · Hormones (Athens, Greece)
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    ABSTRACT: To reappraise the currently available evidence, providing the answer to the following question: does intravenous albumin administration reduce the risk of severe ovarian hyperstimulation syndrome (OHSS) occurrence following ovarian stimulation with gonadotrophins and GnRH analogues for IVF in high-risk patients? Systematic review and metaanalysis. University-based hospital. Intravenous albumin administration in high-risk patients for prevention of severe OHSS occurrence. Severe OHSS occurrence. Eight eligible randomized controlled trials were identified (n=1,199 patients) that offered data for statistical pooling. No statistically significant difference in the occurrence of severe OHSS in patients who received intravenous albumin (n=595) and those who did not (n=604; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.52-1.22) was detected. Moreover, no statistically significant differences were present regarding the probability of pregnancy (OR, 0.83; 95% CI, 0.64-1.07) and first trimester pregnancy loss (OR, 1.44; 95% CI, 0.73-2.85) between patients who received intravenous albumin and those who did not. Based on the currently best available evidence, intravenous albumin administration in high-risk patients does not appear to reduce the occurrence of severe OHSS. This finding should be considered when implementing strategies for severe OHSS prevention.
    No preview · Article · Jan 2011 · Fertility and sterility
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    ABSTRACT: A non-invasive test, which could predict the presence of sperm during a testicular sperm extraction (TESE) procedure in men with non-obstructive azoospermia (NOA), would be of profound clinical importance. Inhibin B (Inh-B) and anti-Müllerian hormone (AMH) have been proposed as direct markers of Sertoli cell function and indirect markers of spermatogenesis. A search was conducted in the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through June 2009. Thirty-six different studies reported data on the predictive value of one or more index markers (serum Inh-B: 32 studies, seminal Inh-B: 5 studies, serum AMH: 2 studies, seminal AMH: 4 studies) and were included in the systematic review. Nine studies, which had serum Inh-B as index marker, met the predefined criteria and were included in the meta-analysis. Serum Inh-B demonstrated a sensitivity of 0.65 (95% confidence interval [CI]: 0.56-0.74) and a specificity of 0.83 (CI: 0.64-0.93) for the prediction of the presence of sperm in TESE. When the pre-test probability of 41% was incorporated in a Fagan's nomogram, resulted in a positive post-test probability of 73% and a negative post-test probability of 23% for the presence of sperm in TESE. Serum Inh-B cannot serve as a stand-alone marker of persistent spermatogenesis in men with NOA. Although limited, evidence on serum AMH and serum/seminal AMH do not support their diagnostic value in men with NOA.
    Preview · Article · Oct 2010 · Human Reproduction Update
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    ABSTRACT: Although both serum inhibin B (Inh-B) and anti-Müllerian hormone (AMH) concentrations have been proposed as markers of spermatogenesis in men with subfertility, there are wide overlaps with fertile controls. The main aim of this study was to evaluate stimulated serum Inh-B and AMH concentrations in men with non-obstructive azoospermia (NOA). Thirty-seven men with NOA confirmed by testicular fine-needle aspiration and 17 fertile controls participated at this prospective, case-control study. All subjects underwent the Exogenous FSH SErtoli Reserve Test (EFSERT): estimation of serum Inh-B and AMH concentrations before, 24 and 48 hours after administration of 300 IU human recombinant FSH (hrFSH). Basal serum Inh-B and AMH concentrations, as well as Inh-B concentrations at 24 and 48 h were lower in men with NOA as compared to controls. No changes in Inh-B or AMH concentrations were recorded throughout the EFSERT in either men with NOA or controls nor when men with NOA were classified according to their clinical, hormonal and cytological diagnosis. Thus, stimulated serum concentrations of Inh-B and AMH, as obtained by an EFSERT, do not contribute to the diagnostic evaluation of the men with NOA, as the same information can be acquired by the basal serum concentrations of these hormones.
    No preview · Article · Oct 2010 · Gynecological Endocrinology
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    ABSTRACT: Introduction: Ovarian function is controlled not only by endocrine system, but also by autocrine/paracrine regulation in the ovarian cells, which may be mediated by a network of cytokines. The aim of this study was to elucidate the involvement of a multifunctional cytokine, interleukin-6 (IL-6), in human ovarian function especially in human luteolysis. Material and Methods: All subjects were women with normal menstrual cycles (28-35 days), which gave their informed consent to participate in this study. The mean age of the subjects was 39.0 ± 8.7 years (range: 22-53 years, n = 37). Ovarian samples were collected at the time of gynecological operation, and follicular or luteal tissue was isolated macroscopically from each sample. Blood serum was also collected at the same time. All subjects were divided into 3 phases of ovarian cycle (follicular, early-mid luteal, and late luteal phase), according to the date of menstrual cycle and serum hormonal values (classified into follicular phase, if progesterone (P) < 2.0 ng/ml, classified into early-mid luteal phase, if progesterone (P) > 2.0 ng/ml, and classified into late luteal phase, if E2 < 80 pg/ml) at the point of operation. The relative expression levels of IL-6 (n = 37) and its receptors (gp130 and IL-6Rα, n = 21) mRNA in granulosa, theca and luteal cells were analyzed with quantitative RT–PCR using TaqMan technology. The relative values of IL-6 protein in the ovarian tissue were also analyzed with immunoblotting (n = 21). The localization of IL-6 and its receptors, gp130 and IL-6Rα, in the ovarian tissues was examined by immunohistochemical staining (n = 8). All data are presented as the mean ± S.D. Inter-group differences were confirmed with Kruskal-Wallis test, and post-hoc test (Scheffe's F) was used for detecting the significant differences between the groups. Results: The relative level of IL-6 mRNA in late luteal phase (4.46 ± 2.05, n = 8) was significantly higher than those of follicular (1.55 ± 0.94, n = 18: p < 0.00005) and early-mid luteal phase (2.13 ± 0.92, n = 11: p < 0.005). The relative level of mRNA for gp130 in late luteal phase (8.35 ± 5.46, n = 7) was significantly higher than those of follicular phase (1.67 ± 1.93, n = 8: p < 0.05), and the level of IL-6Rα mRNA in late luteal phase (11.66 ± 9.71, n = 7) was significantly higher than those of follicular phase (1.33 ± 2.32, n = 8: p < 0.05) and early-mid luteal phase (2.72 ± 2.40, n = 6: p < 0.05). The relative value of IL-6 protein in the late luteal phase (0.935 ± 0.070, n = 7) was also significantly higher than those of follicular phase (0.751 ± 0.049, n = 8: p < 0.001) and early-mid luteal phase (0.762 ± 0.104, n = 6: p < 0.005). The immunohistochemistry for IL-6 showed positive staining mainly in luteal cells and follicular granulosa cells, and partially in theca cells. The positive staining for gp130 was identified in luteal and granulosa cells as well as the endothelial cells of the capillary vessels. IL-6Rα immunoreactivity was observed in luteal, granulosa and theca cells. Conclusions: Analysis for periodic changes of mRNA and protein revealed that IL-6 was highly expressed in the human ovary of late luteal phase during natural ovarian cycle. The expression of both IL-6 receptors mRNA were also enhanced in the human ovary of late luteal phase during natural ovarian cycle. Immunohistochemical staining showed that IL-6 and its receptors, gp130 and IL-6Rα, were localized in human luteal cells of regressing phase during natural ovarian cycle. These results suggest that IL-6 may act on the corpus luteum of regressing phase and play a significant role to regulate the human ovarian function, possibly as a promoter of human luteolysis.
    Full-text · Article · Jun 2010 · Human Reproduction
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    ABSTRACT: To investigate whether thyroid autoimmunity (TAI) is associated with increased risk for spontaneous miscarriage in subfertile, euthyroid women undergoing IVF. Meta-analysis of observational studies. Four prospective studies that reported data on 1098 subfertile women undergoing IVF (141 with TAI and 957 controls) were included in the meta-analysis. Miscarriage risk ratio (RR). Clinical pregnancy rate and delivery rate. Euthyroid, subfertile women with TAI undergoing IVF demonstrated significantly higher risk for miscarriage compared with controls (four studies-fixed effects RR: 1.99, 95% confidence interval: 1.42- 2.79, P<0.001). No significant difference in clinical pregnancy and delivery rates was detected between groups. Based on the currently available evidence, it appears that the presence of TAI is associated with an increased risk for spontaneous miscarriage in subfertile women achieving a pregnancy through an IVF procedure.
    Full-text · Article · Dec 2009 · European Journal of Endocrinology
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    ABSTRACT: The aim of this study was to assess whether the levels of physical activity before and during early pregnancy are associated with the prevalence of gestational diabetes mellitus (GDM). The study group included 160 puerperas. Among them, 40 (25%) diagnosed as having GDM during their recent pregnancy, whereas the remaining 120 (75%) served as controls. The international physical activity questionnaire (IPAQ-Greek version) was applied twice, in an attempt to estimate the level of physical activity before and during early pregnancy. Women who were "inactive" before or during early pregnancy had odds ratio (OR) 7.9 [95% confidence interval (CI) 3.7-16.56] and 1.3 (95% CI 1.2-1.4) of developing GDM, compared to "minimally active" or "active" women, respectively. Pregnancy resulted in a decrease in the level of physical activity (P < 0.005) during early pregnancy, independently of the diagnosis of GDM and morbidity during early pregnancy. We conclude that physical inactivity before and during early pregnancy is associated with increased risk for developing GDM in late pregnancy.
    No preview · Article · Aug 2009 · Acta Diabetologica
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    ABSTRACT: Seminal plasma transferrin levels were estimated in 51 men with various infertility problems and in 15 fertile subjects. The estimation of transferrin was carried out by using the radial immunodiffusion technique on LC-partigen transferrin plates. The mean value of transferrin decreased (p less than .05) in cases of azoospermia (91 +/- 51 micrograms/ejaculate). No significant difference was found in other sperm quality disorders (asthenoteratospermia = 227 +/- 141, mild OTA = 186 +/- 96, severe OTA = 247 +/- 137 micrograms/ejaculate). The mean value of transferrin decreased (p less than .05) in obstructive azoospermia cases (73 +/- 70 micrograms/ejaculate), whereas in the other causes of infertility no statistical differences were found. Transferrin was correlated with sperm count, sperm volume, and serum LH.
    No preview · Article · Jul 2009 · Archives of Andrology
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    ABSTRACT: The mechanism explaining the association between first-trimester spontaneous miscarriages and the presence of thyroid autoimmunity remains unclear. Glycoprotein hormone receptors form a receptor subfamily, in which significant structural similarity is observed. Cross-reactivity between chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH) and their receptors (R) is suggested by the thyrotropic action of hCG during pregnancy and in patients with choriocarcinomas as well as by reports of precocious puberty in patients with juvenile hypothyroidism. If TSH can activate LH/CG-R, then, the TSH-R blocking autoantibodies could bind and block LH/CG-R in the corpus luteum through a similar cross-reactivity process. This inhibition could lead to a decrease in steroid hormones production, essential for the support of pregnancy during the first trimester and result in spontaneous miscarriages. This hypothesis, if confirmed, might have major clinical implications, such as the detection of high-risk pregnancies and the elucidation of progesterone role in the prevention of miscarriages.
    No preview · Article · Jul 2009 · Medical Hypotheses
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    ABSTRACT: Conflicting results regarding adiponectin levels in women with polycystic ovary syndrome (PCOS) have been reported. To evaluate adiponectin levels in PCOS, a systematic review of all studies comparing adiponectin levels in women with PCOS with healthy controls and a meta-analysis of those involving women with similar body mass index (BMI) were performed. The influence of possible effect modifiers, such as insulin resistance (IR) and testosterone, was investigated. The influence of obesity was investigated through a 'nested' meta-analysis after within-study BMI stratification and appropriate pooling. Literature search was conducted through MEDLINE, EMBASE, Cochrane CENTRAL (through June 2008), references from relevant studies and personal contact with the authors. Thirty-one studies, reporting data on 3469 subjects, were reviewed and 16 included in the main meta-analysis. Women with PCOS demonstrated significantly lower adiponectin values [weighted mean difference (95% confidence interval) -1.71 (-2.82 to -0.6), P < 10(-4)], yet with significant between-study heterogeneity. Lower adiponectin levels are associated with the IR observed in women with PCOS, compared with controls. IR, but not total testosterone, was found significant among biological parameters explored in the meta-regression model. Hypoadiponectinaemia was present in both lean and obese women with PCOS when compared with non-PCOS counterparts. Data on high molecular weight (HMW) adiponectin are limited (three studies). After controlling for BMI-related effects, adiponectin levels seem to be lower in women with PCOS compared with non-PCOS controls. Low levels of adiponectin in PCOS are probably related to IR but not to testosterone. Total adiponectin should not be used as a biomarker of PCOS severity. Further investigation is needed for HMW adiponectin levels in PCOS.
    Preview · Article · Jan 2009 · Human Reproduction Update
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    ABSTRACT: To evaluate the risk of gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS). Systematic review and meta-analysis of observational studies. Tertiary Department of Reproductive Endocrinology. Five thousand two hundred ninety-three pregnant women (721 with PCOS and 4,572 controls without PCOS). Literature search in the electronic databases MEDLINE, EMBASE, and CENTRAL, study of the references of all relevant trials or reviews, and manual search of the abstracts from the major meetings in the field of human reproduction. Gestational diabetes mellitus odds ratio. Women with PCOS demonstrated a significantly higher risk for the development of GDM as compared with women without PCOS (odds ratio 2.89, 95% confidence interval [CI] 1.68-4.98), yet with significant statistical heterogeneity (I(2) = 59.3%), durable to sensitivity analysis. In the subgroup of cohort studies, this finding remained robust (7.11, 95% CI 2.95-17.12), whereas in the subgroup of case-control studies, it did not (0.89, 95% CI 0.38-2.06). Metaregression modeling revealed a linear dependence of the outcome on study type and baseline risk (post hoc). Significant heterogeneity among studies and dependence of the outcome on study type make the higher risk of GDM in women with PCOS a questionable finding. The conduction of properly designed studies should precede any recommendation to pregnant women with PCOS in regard to the risk of GDM.
    Full-text · Article · Sep 2008 · Fertility and sterility

  • No preview · Article · May 2008 · Fertility and sterility
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    ABSTRACT: To determine stimulated serum anti-Mllerian hormone (AMH) levels in men with different causes of subfertility. We prospectively studied 82 subfertile men and 31 controls. The subfertile men underwent a diagnostic procedure to identify the causes of subfertility. Study parameters included testicular volume, levels of follicle-stimulating hormone, luteinizing hormone, total testosterone, prolactin, inhibin B and AMH, and sperm parameters. Clinical diagnoses in subfertile men were idiopathic non-obstructive azoospermia (n = 26, 32%), idiopathic non-obstructive dyspermia (n = 17, 21%), varicocele (n = 16, 20%), cryptorchidism (n = 10, 12%) and other diagnoses (n = 13, 16%). Serum AMH levels in subfertile men were 60% lower than in controls [median (interquartile range) 4.6 (3.6) vs. 11.6 (7.7) ng/ml, p 0.001], with no significant differences among the different groups of subfertile men. Serum AMH levels differentiate control from subfertile men but not men with different causes of subfertility.
    No preview · Article · Apr 2008 · Gynecological Endocrinology
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    ABSTRACT: To compare FSH, inhibin B (INHB), and anti-Müllerian hormone (AMH) as predictors of the recovery of sperm in testicular fine-needle aspiration biopsy (FNA) performed in men with azoospermia. Cross-sectional, clinical study. Academic Unit of Reproductive Endocrinology. Fifty-one men with azoospermia and 31 controls. Testicular FNA. Serum FSH, INHB, and AMH levels. Clinical diagnoses in men with azoospermia were idiopathic nonobstructive azoospermia (n = 34, 67%), cryptorchidism (n = 4, 8%), varicocele (n = 3, 6%), and other diagnoses (n = 10, 16%). In pairwise comparison of receiver operating characteristic curves, none of FSH (area under curve 0.716), INHB (0.610), AMH (0.565), or volume of the larger testis (0.693) was proved to be superior to the others as predictor of sperm retrieval during an FNA procedure. Similarly, in a logistic regression analysis, none of FSH, AMH, INHB, or volume of the larger testis could predict presence of sperm in FNA. Serum INHB and AMH, as well as their combination, are not superior to FSH as predictors of the presence of sperm in testicular FNA in men with azoospermia and should not be used for this purpose.
    No preview · Article · Apr 2008 · Fertility and sterility
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    ABSTRACT: The aim of this study was the comparison of liquid-based cytology (ThinPrep, TS) to conventional smears (CS) in the investigation of subfertile men with testicular fine-needle aspiration (FNA). Between January and December 2004, testicular FNA biopsies were performed in 30 subfertile men. Both TS and CS were diagnosed according to Meng classification. Features specifically recorded in each smear included sample adequacy, tissue cells preservation, contamination with red blood cells, quality of smear background, ease of cell recognition, and the cytological diagnosis. There was agreement in the cytological diagnosis between TS and CS (P = 0.88) and sample adequacy (P = 0.73). TS was superior to CS regarding cell preservation, presence of red blood cells or tissue artifacts, quality of the smear background, and cell recognition (P < 0.0001). In testicular FNA cytology, TS appear to be superior to CS in respect to cell preservation, absence of red blood cells, background quality, and cell recognition. These advantages, however, are not translated in improved cytological diagnosis. Diagn. Cytopathol. 2008;36:1–7.
    Full-text · Article · Jan 2008 · Diagnostic Cytopathology
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    ABSTRACT: Inhibin-B (Inh-B) is produced by Sertoli cells and controls Follicle Stimulating Hormone (FSH) secretion through a negative feedback mechanism. The primary aim of this study was to compare Iotanh-B with FSH as predictors of the recovery of sperm in testicular fine needle aspirate in men with azoospermia. In 51 men with azoospermia basal values of Luteinizing Hormone (LH), FSH, prolactin and testosterone as well as Inh-B values before and 24 h and 48 h after the administration of 300 IU recombinant human FSH were determined. Testicular Fine Needle Aspiration (FNA) was also carried out. Thirty-one young healthy men were also enrolled in the study as controls. There was significant difference between men with azoospermia and controls with regard to the basal Inh-B levels [median (interquartile range) 37.2 (36) vs. 103.0 (90) pg/mL, respectively, p=0.003] but not to the stimulated Inh-B levels [40.5 (41) vs. 73.0 (44) pg/mL, p=0.113 at 24 h and 34.3 (34) vs. 82.0 (50) pg/mL, p=0.098 at 48 h)]. The Area Under Curve in Receiver Operating Characteristic curves were similar for Inh-B and FSH (0.610 vs. 0.716, respectively, p=0.151) as far as prediction of sperm retrieval is concerned. Basal serum Inh-B values are significantly lower in men with azoospermia compared to controls. However, Inh-B is not superior to FSH in predicting the presence of sperm in testicular fine needle aspirate.
    Full-text · Article · Nov 2007 · Hormones (Athens, Greece)
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    P D Kantartzi · Ch D Goulis · G D Goulis · I Papadimas
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    ABSTRACT: Varicocele is among the most common causes of male infertility. It is also one of the most controversial issues in the field of Andrology, especially regarding why, when and to whom varicocelectomy should be applied. Many experts believe that the surgical repair of varicocele should be applied only in a meticulously selected group of infertile men, although there are no generally accepted criteria. Up to now, the only confirmed prognostic factor for achievement of pregnancy after varicocelectomy is the age of the female partner. Given the wide application of intra-cytoplasmic sperm injection (ICSI) during the last few years, the modern research approaches should compare the benefits of varicocelectomy and ICSI, taking under consideration both the efficacy and the cost-effectiveness of the methods.
    Full-text · Article · Aug 2007 · Hippokratia

Publication Stats

393 Citations
69.31 Total Impact Points

Institutions

  • 2006-2013
    • Aristotle University of Thessaloniki
      • • Department of Obstetrics and Gynecology IV
      • • Endocrinology of Reproduction Unit
      Saloníki, Central Macedonia, Greece
  • 2006-2009
    • Papageorgiou Hospital
      Saloníki, Central Macedonia, Greece