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Sengupta P, Dutta S, Jegasothy R, Slama P, Cho CL, Roychoudhury S. 'Intracytoplasmic sperm injection (ICSI) paradox' and 'andrological ignorance': AI in the era of fourth industrial revolution to navigate the blind spots. Reprod Biol Endocrinol 2024; 22:22. [PMID: 38350931 PMCID: PMC10863146 DOI: 10.1186/s12958-024-01193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
The quandary known as the Intracytoplasmic Sperm Injection (ICSI) paradox is found at the juncture of Assisted Reproductive Technology (ART) and 'andrological ignorance' - a term coined to denote the undervalued treatment and comprehension of male infertility. The prevalent use of ICSI as a solution for severe male infertility, despite its potential to propagate genetically defective sperm, consequently posing a threat to progeny health, illuminates this paradox. We posit that the meteoric rise in Industrial Revolution 4.0 (IR 4.0) and Artificial Intelligence (AI) technologies holds the potential for a transformative shift in addressing male infertility, specifically by mitigating the limitations engendered by 'andrological ignorance.' We advocate for the urgent need to transcend andrological ignorance, envisaging AI as a cornerstone in the precise diagnosis and treatment of the root causes of male infertility. This approach also incorporates the identification of potential genetic defects in descendants, the establishment of knowledge platforms dedicated to male reproductive health, and the optimization of therapeutic outcomes. Our hypothesis suggests that the assimilation of AI could streamline ICSI implementation, leading to an overall enhancement in the realm of male fertility treatments. However, it is essential to conduct further investigations to substantiate the efficacy of AI applications in a clinical setting. This article emphasizes the significance of harnessing AI technologies to optimize patient outcomes in the fast-paced domain of reproductive medicine, thereby fostering the well-being of upcoming generations.
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Affiliation(s)
- Pallav Sengupta
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University (GMU), Ajman, UAE.
| | - Sulagna Dutta
- Basic Medical Sciences Department, College of Medicine, Ajman University, Ajman, UAE
| | - Ravindran Jegasothy
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, Kuala Lumpur, Malaysia
| | - Petr Slama
- Laboratory of Animal Immunology and Biotechnology, Department of Animal Morphology, Physiology and Genetics, Faculty of AgriSciences, Mendel University in Brno, Brno, Czech Republic
| | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
Gender affirming medical and surgical treatments affect the reproductive potential of transgender individuals. Prior to the development of assisted reproductive technologies (ART), genital gender-affirming surgery frequently eliminated a patient’s reproductive potential. Today, all patients should be counseled on their fertility preservation (FP) options before medical and surgical transition, yet this appears to seldom occur in practice. The following review is the result of a systematic literature search of PubMed, Medline and Google Scholar to identify current and future FP options, barriers to treatment patients face, practice patterns of transgender health care providers, and if there were any standardized counseling protocols. Options for transwomen at any point in their transition range from simply providing a semen sample to be used with assistive reproductive techniques to experimental techniques involving testicular cryopreservation followed by in vitro initiation of spermatogenesis. Transmen before and after starting hormone therapy can pursue any assistive reproductive techniques available for ciswomen. Future options currently under investigation include ovarian tissue cryopreservation (OTC) with in vitro oocyte maturation. In addition to counseling about their FP options, patients should be advised prospectively about the requirements, process details, the total costs associated with achieving pregnancy, and the inherent risks associated with using preserved genetic material including risk of failure, and maternal and fetal health risks. Transgender patients report using assistive reproductive services difficult, due to a lack of dialogue about fertility and the lack of information offered to them- presumably because their circumstances do not fit into a traditional narrative familiar to providers. Physicians and health care providers would benefit from better educational tools to help transgender patients make informed decisions and better training about transgender patients in general, and FP options available to them.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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Giahi L, Mohammadmoradi S, Javidan A, Sadeghi MR. Nutritional modifications in male infertility: a systematic review covering 2 decades. Nutr Rev 2016; 74:118-30. [PMID: 26705308 PMCID: PMC4892303 DOI: 10.1093/nutrit/nuv059] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 07/09/2015] [Accepted: 08/01/2015] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Studies suggest that appropriate nutritional modifications can improve the natural conception rate of infertile couples. OBJECTIVES The purpose of this study was to review the human trials that investigated the relation between nutrition and male infertility. DATA SOURCES A comprehensive systematic review of published human studies was carried out by searching scientific databases. Article selection was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The American Dietetic Association Research Design and Implementation Checklist was also used for quality assessment. DATA EXTRACTION A total of 502 articles were identified, of which 23 studies met the inclusion criteria. DATA SYNTHESIS Results indicated that a healthy diet improves at least one measure of semen quality, while diets high in lipophilic foods, soy isoflavones, and sweets lower semen quality. CONCLUSION The role of daily nutrient exposure and dietary quality needs to be highlighted in male infertility. Mechanistic studies addressing the responsible underlying mechanisms of action of dietary modifications are highly warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2013: CRD42013005953. Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005953.
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Affiliation(s)
- Ladan Giahi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran.
| | - Shayan Mohammadmoradi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Aida Javidan
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Mohammad Reza Sadeghi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
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Kim JW, Kim SD, Yang SH, Yoon SH, Jung JH, Lim JH. Successful pregnancy after SrCl2oocyte activation in couples with repeated low fertilization rates following calcium ionophore treatment. Syst Biol Reprod Med 2014; 60:177-82. [DOI: 10.3109/19396368.2014.900832] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brown DB, Merryman DC, Rivnay B, Houserman VL, Long CA, Honea KL. Evaluating a novel panel of sperm function tests for utility in predicting intracytoplasmic sperm injection (ICSI) outcome. J Assist Reprod Genet 2013; 30:461-77. [PMID: 23526053 PMCID: PMC3644129 DOI: 10.1007/s10815-013-9960-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 11/18/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate a panel of three sperm function tests; tests known to assess different aspects of sperm functionality and genomic integrity, the: 1) Sperm DNA Accelerated Decondensation (SDAD(TM)) Test, 2) Sperm DNA Decondensation (SDD(TM)) Test, and 3) Sperm Penetration Assay (SPA), determining if positive and negative test scores correlated with failed and successful ICSI outcomes, respectfully. METHODS A prospective, double blinded, cohort study was performed. One study sample (ejaculated semen) was collected by each of the 60 male partners of the 60 couples enrolled in the study; males whose female partners were found to have no major female factor issues. The sperm from each male was analyzed in the SPA, and SDAD and SDD Tests, and used for ICSI (1 ICSI cycle per couple). RESULTS The ICSI cycle pregnancy rate for this study was 50 %, with a delivery rate=40 % (n=60 ICSI cycles). The SPA and SDD Test scores did not significantly predict ICSI outcome when used as stand-alone tests (p>>0.05). However, when the SPA and SDD Test scores were used together, ICSI outcomes for a subgroup of 10 (16.7 %) males, were significantly predicted (p=0.03), with 1 live birth, and 9 negatives where the transferred embryos did not implant. In total, 38.4 % of the couples in this study were found to have a very poor chance for a successful ICSI cycle. CONCLUSION SDAD Test scores alone, and SPA and SDD Test scores used together, significantly predicted failed ICSI outcomes. This indicates that the scores obtained when analyzing patients' sperm using a panel of sperm function tests; specifically, the SPA, and SDAD and SDD Tests, can be used to identify infertile couples who should not be directed to ICSI.
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Affiliation(s)
- David B Brown
- ART Fertility Program of Alabama, Birmingham, AL 35209, USA.
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A Noninvasive, Motility Independent, Sperm Sorting Method and Technology to Identify and Retrieve Individual Viable Nonmotile Sperm for Intracytoplasmic Sperm Injection. J Urol 2010; 184:2466-72. [DOI: 10.1016/j.juro.2010.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Indexed: 11/23/2022]
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Rodowicz KA, Francisco H, Layton B. Determination of the mechanical properties of DOPC:DOPS liposomes using an image procession algorithm and micropipette-aspiration techniques. Chem Phys Lipids 2010; 163:787-93. [PMID: 20863821 DOI: 10.1016/j.chemphyslip.2010.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 09/11/2010] [Accepted: 09/14/2010] [Indexed: 02/01/2023]
Abstract
Quantification of the mechanical properties of liposomes is critical in helping to predict their behavior during various applications such as targeted drug delivery, response to mechanical characterization or their interactions with isolated cytoskeletal elements. A numerical implementation of the Evans aspiration technique, and an image processing algorithm for measuring deformation of spherical DOPC:DOPS liposomes is presented. Liposomes were aspirated to pressures of -10mmHg (∼-1300Pa). The area expansion and Young's moduli of the liposomes were found to be 0.067Nm⁻¹ (67±4dyn/cm) and 15±1 MPa.
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Affiliation(s)
- Kathleen Allen Rodowicz
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA 19104, USA
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Ross C, Morriss A, Khairy M, Khalaf Y, Braude P, Coomarasamy A, El-Toukhy T. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online 2010; 20:711-23. [DOI: 10.1016/j.rbmo.2010.03.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 12/09/2009] [Accepted: 02/04/2010] [Indexed: 12/25/2022]
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O'Flynn O'Brien KL, Varghese AC, Agarwal A. The genetic causes of male factor infertility: a review. Fertil Steril 2010; 93:1-12. [PMID: 20103481 DOI: 10.1016/j.fertnstert.2009.10.045] [Citation(s) in RCA: 280] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 10/27/2009] [Accepted: 10/27/2009] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To illustrate the necessity for an enhanced understanding of the genetic basis of male factor infertility, to present a comprehensive synopsis of these genetic elements, and to review techniques being utilized to produce new insights in fertility research. BACKGROUND Male factor infertility is a complex disorder that affects a large sector of the population; however, many of its etiologies are unknown. By elucidating the underlying genetic basis of infertile phenotypes, it may be possible to discover the causes of infertility and determine effective treatments for patients. METHOD(S) The PubMed database was consulted for the most relevant papers published in the last 3 years pertaining to male factor infertility using the keywords "genetics" and "male infertility." RESULT(S) Advances have been made in the characterization of the roles of specific genes, but further research is necessary before these results can be used as guidelines for diagnosing and treating male factor infertility. The accurate transmission of epigenetic information also has considerable influence on fertility in males and on the fertility of their offspring. CONCLUSION(S) Analysis of the genetic factors that impact male factor infertility will provide valuable insights into the creation of targeted treatments for patients and the determination of the causes of idiopathic infertility. Novel technologies that analyze the influence of genetics from a global perspective may lead to further developments in the understanding of the etiology of male factor infertility through the identification of specific infertile phenotype signatures.
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Affiliation(s)
- Katherine L O'Flynn O'Brien
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Varghese AC, Bragais FM, Mukhopadhyay D, Kundu S, Pal M, Bhattacharyya AK, Agarwal A. Human sperm DNA integrity in normal and abnormal semen samples and its correlation with sperm characteristics. Andrologia 2009; 41:207-15. [DOI: 10.1111/j.1439-0272.2009.00917.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kheirollahi-Kouhestani M, Razavi S, Tavalaee M, Deemeh M, Mardani M, Moshtaghian J, Nasr-Esfahani M. Selection of sperm based on combined density gradient and Zeta method may improve ICSI outcome. Hum Reprod 2009; 24:2409-16. [DOI: 10.1093/humrep/dep088] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Although the derivation of mice by intracytoplasmic sperm injection (ICSI) using freeze-dried sperm has been demonstrated previously, a comprehensive analysis of their viability, health, and fertility has not. The purpose of the present study was to determine the extent to which ICSI using freeze-dried sperm stored at 4 degrees C for 1-2 months from mice on either an inbred (C57BL/6J) or hybrid (B6D2F1/J) genetic background results in genomic instability and/or phenotypic abnormality in mice and two generations of their progeny. Fertilization rates (number of 2-cells per injected oocytes) using ICSI of fresh and freeze-dried sperm were similar within and between mouse strains, although fewer freeze-dried sperm-derived embryos than fresh sperm-derived embryos developed to blastocysts in vitro (C57BL/6J and B6D2F1/J) and liveborn pups in vivo (B6D2F1/J only). Nevertheless, once born, mice derived by ICSI using freeze-dried sperm in both mouse strains were healthy and reproductively sound. No major differences in litter size, weaning rate, and sex ratio were noted in the two generations of progeny (F2 and F3) of ICSI-derived offspring using freeze-dried sperm compared with that in the natural mating (control) group. Further, there was no evidence that either ICSI or freeze drying induced genomic instability, as determined by microsatellite analysis of the derived mice and subsequent generations when compared with both parental genotypes, nor were there differences in the number or types of pathological changes in any of the three generations of progeny. We conclude that viable, healthy and genomically stable mice can be derived by ICSI using freeze-dried mouse sperm stored in the refrigerator for at least 2 months. Further, because freeze drying is a simpler and more economical technique compared with embryo and sperm cryopreservation, the results of this study justify additional research to continue to develop and enhance the technique for the preservation, storage, and sharing of genetically altered mice.
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Petersen CG, Oliveira JBA, Mauri AL, Massaro FC, Baruffi RLR, Pontes A, Franco JG. Relationship between visualization of meiotic spindle in human oocytes and ICSI outcomes: a meta-analysis. Reprod Biomed Online 2009; 18:235-43. [PMID: 19192344 DOI: 10.1016/s1472-6483(10)60261-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this meta-analysis was to investigate the influence of meiotic spindle visualization in human oocytes on intracytoplasmic sperm injection (ICSI) outcomes. Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and Ovid). The fixed effect was used for odds ratio. Ten trials fulfilled the inclusion criteria comparing in-vitro and clinical ICSI outcomes with or without visualization of meiotic spindle in fresh and in-vivo matured oocytes. According to the meta-analysis, the results showed statistically significant higher fertilization rate (P < 0.0001) when the meiotic spindle was viewed than when it was not. Moreover, the percentage of pro-nuclear-stage embryos with good morphology (P = 0.003), cleavage rate (P < 0.0001), percentage of day-3 top-quality embryos (P = 0.003) and percentage of embryos that reached the blastocyst stage (P < 0.0001) were statistically significantly better among embryos derived from oocytes in which meiotic spindle was viewed compared with those in which meiotic spindle was not observed. However, these differences were not observed in the clinical pregnancy or implantation rates. This observation has clinical relevance mainly in countries where there is a legal limit on the number of oocytes to be fertilized. However, additional controlled trials are needed to further confirm these results.
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Affiliation(s)
- C G Petersen
- Center for Human Reproduction Prof. Franco Junior, Av. Prof. João Fiusa, 689, 14025-310, Ribeirão Preto, SP, Brazil
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Varghese AC, Peter Nagy Z, Agarwal A. Current trends, biological foundations and future prospects of oocyte and embryo cryopreservation. Reprod Biomed Online 2009. [DOI: 10.1016/s1472-6483(10)60181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current trends, biological foundations and future prospects of oocyte and embryo cryopreservation. Reprod Biomed Online 2009; 19:126-40. [DOI: 10.1016/s1472-6483(10)60056-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kyono K, Kumagai S, Nishinaka C, Nakajo Y, Uto H, Toya M, Sugawara J, Araki Y. Birth and follow-up of babies born following ICSI using SrCl2 oocyte activation. Reprod Biomed Online 2008; 17:53-8. [PMID: 18616891 DOI: 10.1016/s1472-6483(10)60293-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report describes six successful pregnancies (five healthy children from four deliveries and two miscarriages) with SrC1(2) oocyte activation using spermatozoa from nine patients with repeated fertilization failure. Oocytes were artificially activated by SrC1(2) 30 min after intracytoplasmic sperm injection (ICSI). Oocytes were placed in 10 mmol/l of SrC1(2) medium for 1 h, rinsed several times, and then cultured in Universal IVF medium. Developmental characteristics of five resulting children until 1 year old were assessed according to the maternal and children health hand book issued by Mothers' and Children's Health Organization in Japan. Mean fertilization rate, mean frequency of good cleaved embryos, pregnancy rate, and implantation rate after artificial activation in nine couples were increased from 21.7 to 64.5% (P < 0.001), from 0 to 15.4%, from 0 to 40.0% and from 0 to 25.0% respectively. Five healthy children were born following ICSI and artificial activation between February 2005 and March 2006. Physical and mental development of the children from birth to 12 months was normal. These suggest the utility and safety of SrCl(2) for patients with repeated failed fertilizations following ICSI and artificial activation.
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Affiliation(s)
- Koichi Kyono
- Kyono ART Clinic, 3F Mitsuiseimei Sendai Honcho Building, 1-1-1 Honcho, Aobaku, Sendai 980-0014, Japan.
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Abstract
The aim of this study was to determine the extent of DNA fragmentation and the presence of denatured single-stranded or normal double-stranded DNA in spermatozoa with large nuclear vacuoles (LNV) selected by high magnification. Fresh semen samples from 30 patients were prepared by discontinuous isolate concentration gradient. Spermatozoa with normal nucleus (NN) and LNV were selected at x8400 magnification and placed on different slides. DNA fragmentation was determined by TUNEL assay. Denatured and double-stranded DNA was identified by the acridine orange fluorescence method. DNA fragmentation in spermatozoa with LNV (29.1%) was significantly higher (P < 0.001) than in spermatozoa with NN (15.9%). Therefore, cleavage of genomic DNA in low molecular weight DNA fragments (mono- and oligonucleosomes), and single-strand breaks (nicks) in high molecular weight DNA occur more frequently in spermatozoa with LNV. Similarly, the percentage of denatured-stranded DNA in spermatozoa with LNV (67.9%) was significantly higher (P < 0.0001) than in spermatozoa with NN (33.1%). The high level of denatured DNA in spermatozoa with LNV suggests precocious decondensation and disaggregation of sperm chromatin fibres. The results show an association between LNV and DNA damage in spermatozoa, and support the routine morphological selection and injection of motile spermatozoa at high magnification for ICSI.
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Garolla A, Fortini D, Menegazzo M, De Toni L, Nicoletti V, Moretti A, Selice R, Engl B, Foresta C. High-power microscopy for selecting spermatozoa for ICSI by physiological status. Reprod Biomed Online 2008; 17:610-6. [DOI: 10.1016/s1472-6483(10)60307-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ludwig AK, Katalinic A, Jendrysik J, Thyen U, Sutcliffe AG, Diedrich K, Ludwig M. Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany. Reprod Biomed Online 2008; 17:403-9. [DOI: 10.1016/s1472-6483(10)60225-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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