The Effect of Pre-treatment With GnRH Analogues Prior in Vitro Fertilization in Patients With Endometriosis

NCT ID: NCT01581359

Last Updated: 2015-10-22

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-03-31
• Study Completion Date: 2015-05-31

Brief Summary

The purpose of this study is to determine whether the administration of an analogue of gonadotropin-releasing hormone (GnRH) during the three months prior to the performing of an IVF may improve the response to ovarian stimulation, implantation rate and clinical pregnancy rate in patients with endometriosis/ endometriomas.

Detailed Description

Endometriosis is defined as the presence of ectopic endometrial tissue which induces a local inflammatory reaction. Usually, this tissue is located at any level in the pelvic region, but extrapelvic locations have been described. It is a chronic disease whose cause is unknown, although a genetic predisposition has been proven. It is estimated that endometriosis affects 7-15% of women of fertile age, and up to 30-40% of women with endometriosis have infertility.

Assisted reproduction techniques (ART) are the treatment of many causes of infertility, including endometriosis. The results of assisted reproduction in women with endometriosis appear to be somewhat worse than those obtained from women without endometriosis. Some authors have proven a significant reduction in implantation and pregnancy rates in these patients.

The worst pregnancy rate and implantation is believed to be originated in a poor oocyte quality, which can lead to a lower rate of fertilization. This poor oocyte quality produce poorer quality embryos with a reduced capacity to implant, particularly in severe endometriosis.

On the other hand, endometrial receptivity does not appear to contribute to the reduction of results of ART in these women.

In an attempt to improve ART outcomes in women with endometriosis, different strategies have been proposed prior to the cycle realization, with different results.

Surgical resection of endometriomas (endometriosis cysts) before the cycle of IVF/ICSI may adversely affect the results. On the other hand, careful laparoscopic cystectomy appears not to affect the ovarian response to stimulation.

In addition to surgical approaches, have been tried different medical treatments to improve the results of IVF / intracytoplasmatic sperm injection (ICSI) in women with endometriosis. It has been suggested that treatment with Danazol prior to IVF may improve results. Similarly, prolonged treatment with GnRH analogues few months before IVF could improve the implantation and pregnancy rates. Unfortunately, many of these studies were not randomized and / or controlled so that the true value of therapy with GnRH analogues before IVF in women with endometriosis still needs to be valued. A recent meta-analysis showed that a 3-6 month treatment with GnRH analogues before IVF increased 4 times the odds of clinical pregnancy in women with endometriosis. Nevertheless, these results were concluded from 165 patients and 78 pregnancies, included in 3 clinical trials, which was not specifically to patients with endometriomas.

The lack of studies with proper design, suggests that there is insufficient evidence at present to establish firm recommendations in this regard. This study will contribute to increasing scientific evidence to recommend or not pretreatment with GnRH agonists before IVF en patients with endometriosis.

Conditions

Endometriosis; Infertility

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

GnRHa

Triptorelin acetate 3,75 mg subcutaneous injection administered on days 1, 28 and 56 after menstrual cycle.

Group Type: ACTIVE_COMPARATOR

Triptorelin acetate

Intervention Type: DRUG

• Triptorelin acetate Dosing regimen: 1 subcutaneous injection of 3,75 mg/28 days, total of 3 doses
• Placebo Dosing regimen: subcutaneous injection of the same volume of physiological serum/28 days, total of 3 doses

Physiological serum

physiological serum subcutaneous injection with same delivery device and same volume that active comparator ) administered on days 1, 28 and 56 after menstrual cycle.

Group Type: PLACEBO_COMPARATOR

Triptorelin acetate

Intervention Type: DRUG

• Triptorelin acetate Dosing regimen: 1 subcutaneous injection of 3,75 mg/28 days, total of 3 doses
• Placebo Dosing regimen: subcutaneous injection of the same volume of physiological serum/28 days, total of 3 doses

Interventions

Triptorelin acetate

• Triptorelin acetate Dosing regimen: 1 subcutaneous injection of 3,75 mg/28 days, total of 3 doses
• Placebo Dosing regimen: subcutaneous injection of the same volume of physiological serum/28 days, total of 3 doses

Intervention Type: DRUG

Other Intervention Names

Gonapeptyl Depot 3,75

Eligibility Criteria

Inclusion Criteria

• Infertile women with endometriosis diagnosed by surgery in the previous year to their inclusion in the study with signs of residual disease and/or by the existence of ovarian endometrioma in vaginal ecography who are susceptible to IVF treatment.
• BMI < 28 Kg/m2
• Age < 40 years old
• Signed informed consent to perform IVF and participation in this study

Exclusion Criteria

• Follicle stimulating hormone (FSH) 2nd-5th cycle day > 12 IU/L
• Liver disease (sALAT> 80 IU/L)
• Kidney disease (creatinine > 130 nmol/L)
• Other relevant disease that contraindicates a pregnancy

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Instituto de Investigacion Sanitaria La Fe

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

ANA Mª MONZÓ, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario La Fe

Locations

Human Reproduction Unit of the La Fe University and Politechnic Hospital

Valencia, Valencia, Spain

Countries

Spain

References

Matson PL, Yovich JL. The treatment of infertility associated with endometriosis by in vitro fertilization. Fertil Steril. 1986 Sep;46(3):432-4. doi: 10.1016/s0015-0282(16)49581-6.

Reference Type: BACKGROUND

PMID: 3091408 (View on PubMed)

Simon C, Gutierrez A, Vidal A, de los Santos MJ, Tarin JJ, Remohi J, Pellicer A. Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod. 1994 Apr;9(4):725-9. doi: 10.1093/oxfordjournals.humrep.a138578.

Reference Type: BACKGROUND

PMID: 8046030 (View on PubMed)

Arici A, Oral E, Bukulmez O, Duleba A, Olive DL, Jones EE. The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program. Fertil Steril. 1996 Mar;65(3):603-7. doi: 10.1016/s0015-0282(16)58162-x.

Reference Type: BACKGROUND

PMID: 8774295 (View on PubMed)

Cahill DJ, Wardle PG, Maile LA, Harlow CR, Hull MG. Ovarian dysfunction in endometriosis-associated and unexplained infertility. J Assist Reprod Genet. 1997 Nov;14(10):554-7. doi: 10.1023/a:1022568331845.

Reference Type: BACKGROUND

PMID: 9447453 (View on PubMed)

Inoue M, Kobayashi Y, Honda I, Awaji H, Fujii A. The impact of endometriosis on the reproductive outcome of infertile patients. Am J Obstet Gynecol. 1992 Jul;167(1):278-82. doi: 10.1016/s0002-9378(11)91675-5.

Reference Type: BACKGROUND

PMID: 1442943 (View on PubMed)

Dmowski WP, Rana N, Michalowska J, Friberg J, Papierniak C, el-Roeiy A. The effect of endometriosis, its stage and activity, and of autoantibodies on in vitro fertilization and embryo transfer success rates. Fertil Steril. 1995 Mar;63(3):555-62. doi: 10.1016/s0015-0282(16)57425-1.

Reference Type: BACKGROUND

PMID: 7851586 (View on PubMed)

Olivennes F, Feldberg D, Liu HC, Cohen J, Moy F, Rosenwaks Z. Endometriosis: a stage by stage analysis--the role of in vitro fertilization. Fertil Steril. 1995 Aug;64(2):392-8. doi: 10.1016/s0015-0282(16)57740-1.

Reference Type: BACKGROUND

PMID: 7615119 (View on PubMed)

Tanbo T, Omland A, Dale PO, Abyholm T. In vitro fertilization/embryo transfer in unexplained infertility and minimal peritoneal endometriosis. Acta Obstet Gynecol Scand. 1995 Aug;74(7):539-43. doi: 10.3109/00016349509024386.

Reference Type: BACKGROUND

PMID: 7618453 (View on PubMed)

Huang HY, Lee CL, Lai YM, Chang MY, Chang SY, Soong YK. The outcome of in vitro fertilization and embryo transfer therapy in women with endometriosis failing to conceive after laparoscopic conservative surgery. J Am Assoc Gynecol Laparosc. 1997 May;4(3):299-303. doi: 10.1016/s1074-3804(05)80219-1.

Reference Type: BACKGROUND

PMID: 9154777 (View on PubMed)

Hickman TN. Impact of endometriosis on implantation. Data from the Wilford Hall Medical Center IVF-ET Program. J Reprod Med. 2002 Oct;47(10):801-8.

Reference Type: BACKGROUND

PMID: 12418061 (View on PubMed)

Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002 Jun;77(6):1148-55. doi: 10.1016/s0015-0282(02)03112-6.

Reference Type: BACKGROUND

PMID: 12057720 (View on PubMed)

Wardle PG, Mitchell JD, McLaughlin EA, Ray BD, McDermott A, Hull MG. Endometriosis and ovulatory disorder: reduced fertilisation in vitro compared with tubal and unexplained infertility. Lancet. 1985 Aug 3;2(8449):236-9. doi: 10.1016/s0140-6736(85)90289-2.

Reference Type: BACKGROUND

PMID: 2862417 (View on PubMed)

Hull MG, Williams JA, Ray B, McLaughlin EA, Akande VA, Ford WC. The contribution of subtle oocyte or sperm dysfunction affecting fertilization in endometriosis-associated or unexplained infertility: a controlled comparison with tubal infertility and use of donor spermatozoa. Hum Reprod. 1998 Jul;13(7):1825-30. doi: 10.1093/humrep/13.7.1825.

Reference Type: BACKGROUND

PMID: 9740433 (View on PubMed)

Bergendal A, Naffah S, Nagy C, Bergqvist A, Sjoblom P, Hillensjo T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility. J Assist Reprod Genet. 1998 Oct;15(9):530-4. doi: 10.1023/a:1022526002421.

Reference Type: BACKGROUND

PMID: 9822979 (View on PubMed)

Pal L, Shifren JL, Isaacson KB, Chang Y, Leykin L, Toth TL. Impact of varying stages of endometriosis on the outcome of in vitro fertilization-embryo transfer. J Assist Reprod Genet. 1998 Jan;15(1):27-31. doi: 10.1023/a:1022574221115.

Reference Type: BACKGROUND

PMID: 9493063 (View on PubMed)

Norenstedt SN, Linderoth-Nagy C, Bergendal A, Sjoblom P, Bergqvist A. Reduced developmental potential in oocytes from women with endometriosis. J Assist Reprod Genet. 2001 Dec;18(12):644-9. doi: 10.1023/a:1013111200251.

Reference Type: BACKGROUND

PMID: 11808845 (View on PubMed)

O'Shea RT, Chen C, Weiss T, Jones WR. Endometriosis and in-vitro fertilisation. Lancet. 1985 Sep 28;2(8457):723. doi: 10.1016/s0140-6736(85)92957-5. No abstract available.

Reference Type: BACKGROUND

PMID: 2863700 (View on PubMed)

Yovich JL, Yovich JM, Tuvik AI, Matson PL, Willcox DL. In-vitro fertilisation for endometriosis. Lancet. 1985 Sep 7;2(8454):552. doi: 10.1016/s0140-6736(85)90485-4. No abstract available.

Reference Type: BACKGROUND

PMID: 2863565 (View on PubMed)

Garrido N, Navarro J, Remohi J, Simon C, Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis. Hum Reprod Update. 2000 Jan-Feb;6(1):67-74. doi: 10.1093/humupd/6.1.67.

Reference Type: BACKGROUND

PMID: 10711831 (View on PubMed)

Pellicer A, Valbuena D, Bauset C, Albert C, Bonilla-Musoles F, Remohi J, Simon C. The follicular endocrine environment in stimulated cycles of women with endometriosis: steroid levels and embryo quality. Fertil Steril. 1998 Jun;69(6):1135-41. doi: 10.1016/s0015-0282(98)00085-5.

Reference Type: BACKGROUND

PMID: 9627305 (View on PubMed)

Pellicer A, Albert C, Mercader A, Bonilla-Musoles F, Remohi J, Simon C. The follicular and endocrine environment in women with endometriosis: local and systemic cytokine production. Fertil Steril. 1998 Sep;70(3):425-31. doi: 10.1016/s0015-0282(98)00204-0.

Reference Type: BACKGROUND

PMID: 9757870 (View on PubMed)

Smith MP, Keay SD, Margo FC, Harlow CR, Wood PJ, Cahill DJ, Hull MG. Total cortisol levels are reduced in the periovulatory follicle of infertile women with minimal-mild endometriosis. Am J Reprod Immunol. 2002 Jan;47(1):52-6. doi: 10.1034/j.1600-0897.2002.1o122.x.

Reference Type: BACKGROUND

PMID: 11885559 (View on PubMed)

Cunha-Filho JS, Lemos NA, Freitas FM, Kiefer K, Faller M, Passos EP. Insulin-like growth factor (IGF)-1 and IGF binding protein-1 and -3 in the follicular fluid of infertile patients with endometriosis. Hum Reprod. 2003 Feb;18(2):423-8. doi: 10.1093/humrep/deg077.

Reference Type: BACKGROUND

PMID: 12571183 (View on PubMed)

Carlberg M, Nejaty J, Froysa B, Guan Y, Soder O, Bergqvist A. Elevated expression of tumour necrosis factor alpha in cultured granulosa cells from women with endometriosis. Hum Reprod. 2000 Jun;15(6):1250-5. doi: 10.1093/humrep/15.6.1250.

Reference Type: BACKGROUND

PMID: 10831550 (View on PubMed)

Nakahara K, Saito H, Saito T, Ito M, Ohta N, Takahashi T, Hiroi M. Ovarian fecundity in patients with endometriosis can be estimated by the incidence of apoptotic bodies. Fertil Steril. 1998 May;69(5):931-5. doi: 10.1016/s0015-0282(98)00038-7.

Reference Type: BACKGROUND

PMID: 9591505 (View on PubMed)

Toya M, Saito H, Ohta N, Saito T, Kaneko T, Hiroi M. Moderate and severe endometriosis is associated with alterations in the cell cycle of granulosa cells in patients undergoing in vitro fertilization and embryo transfer. Fertil Steril. 2000 Feb;73(2):344-50. doi: 10.1016/s0015-0282(99)00507-5.

Reference Type: BACKGROUND

PMID: 10685541 (View on PubMed)

Sung L, Mukherjee T, Takeshige T, Bustillo M, Copperman AB. Endometriosis is not detrimental to embryo implantation in oocyte recipients. J Assist Reprod Genet. 1997 Mar;14(3):152-6. doi: 10.1007/BF02766132.

Reference Type: BACKGROUND

PMID: 9090558 (View on PubMed)

Pellicer A, Oliveira N, Ruiz A, Remohi J, Simon C. Exploring the mechanism(s) of endometriosis-related infertility: an analysis of embryo development and implantation in assisted reproduction. Hum Reprod. 1995 Dec;10 Suppl 2:91-7. doi: 10.1093/humrep/10.suppl_2.91.

Reference Type: BACKGROUND

PMID: 8745306 (View on PubMed)

Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet. 2002 Nov;19(11):507-11. doi: 10.1023/a:1020970417778.

Reference Type: BACKGROUND

PMID: 12484492 (View on PubMed)

Aboulghar MA, Mansour RT, Serour GI, Al-Inany HG, Aboulghar MM. The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol. 2003 Feb;188(2):371-5. doi: 10.1067/mob.2003.13.

Reference Type: BACKGROUND

PMID: 12592242 (View on PubMed)

Canis M, Pouly JL, Tamburro S, Mage G, Wattiez A, Bruhat MA. Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of >3 cm in diameter. Hum Reprod. 2001 Dec;16(12):2583-6. doi: 10.1093/humrep/16.12.2583.

Reference Type: BACKGROUND

PMID: 11726578 (View on PubMed)

Marconi G, Vilela M, Quintana R, Sueldo C. Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation. Fertil Steril. 2002 Oct;78(4):876-8. doi: 10.1016/s0015-0282(02)03326-5.

Reference Type: BACKGROUND

PMID: 12372472 (View on PubMed)

Donnez J, Wyns C, Nisolle M. Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril. 2001 Oct;76(4):662-5. doi: 10.1016/s0015-0282(01)02011-8.

Reference Type: BACKGROUND

PMID: 11591395 (View on PubMed)

Wyns C, Donnez J. [Laser vaporization of ovarian endometriomas: the impact on the response to gonadotrophin stimulation]. Gynecol Obstet Fertil. 2003 Apr;31(4):337-42. doi: 10.1016/s1297-9589(03)00069-9. French.

Reference Type: BACKGROUND

PMID: 12821063 (View on PubMed)

Garcia-Velasco JA, Mahutte NG, Corona J, Zuniga V, Giles J, Arici A, Pellicer A. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril. 2004 May;81(5):1194-7. doi: 10.1016/j.fertnstert.2003.04.006.

Reference Type: BACKGROUND

PMID: 15136074 (View on PubMed)

Dicker D, Goldman JA, Feldberg D, Ashkenazi J, Levy T. Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for in vitro fertilization. J In Vitro Fert Embryo Transf. 1991 Oct;8(5):286-9. doi: 10.1007/BF01139786.

Reference Type: BACKGROUND

PMID: 1757743 (View on PubMed)

Suganuma N, Wakahara Y, Ishida D, Asano M, Kitagawa T, Katsumata Y, Moriwaki T, Furuhashi M. Pretreatment for ovarian endometrial cyst before in vitro fertilization. Gynecol Obstet Invest. 2002;54 Suppl 1:36-40; discussion 41-2. doi: 10.1159/000066293.

Reference Type: BACKGROUND

PMID: 12441659 (View on PubMed)

Dicker D, Ashkenazi J, Feldberg D, Levy T, Dekel A, Ben-Rafael Z. Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for in vitro fertilization and embryo transfer. Fertil Steril. 1993 Jun;59(6):1313-5. doi: 10.1016/s0015-0282(16)55997-4.

Reference Type: BACKGROUND

PMID: 8495784 (View on PubMed)

Yaron Y, Peyser MR, Samuel D, Amit A, Lessing JB. Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod. 1994 Sep;9(9):1759-60. doi: 10.1093/oxfordjournals.humrep.a138789.

Reference Type: BACKGROUND

PMID: 7836533 (View on PubMed)

Nargund G, Parsons J. Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod. 1995 Jun;10(6):1555. doi: 10.1093/humrep/10.6.1555-a. No abstract available.

Reference Type: BACKGROUND

PMID: 7593536 (View on PubMed)

Younis JS, Ezra Y, Laufer N, Ohel G. Late manifestation of pelvic abscess following oocyte retrieval, for in vitro fertilization, in patients with severe endometriosis and ovarian endometriomata. J Assist Reprod Genet. 1997 Jul;14(6):343-6. doi: 10.1007/BF02765839.

Reference Type: BACKGROUND

PMID: 9226514 (View on PubMed)

Wei CF, Chen SC. Pelvic abscess after ultrasound-guided aspiration of endometrioma: a case report. Zhonghua Yi Xue Za Zhi (Taipei). 1998 Oct;61(10):603-7.

Reference Type: BACKGROUND

PMID: 9830238 (View on PubMed)

Kim CH, Chae HD, Kang BM, Chang YS, Mok JE. The immunotherapy during in vitro fertilization and embryo transfer cycles in infertile patients with endometriosis. J Obstet Gynaecol Res. 1997 Oct;23(5):463-70. doi: 10.1111/j.1447-0756.1997.tb00874.x.

Reference Type: BACKGROUND

PMID: 9392913 (View on PubMed)

Tei C, Miyazaki T, Kuji N, Tanaka M, Sueoka K, Yoshimura Y. Effect of danazol on the pregnancy rate in patients with unsuccessful in vitro fertilization-embryo transfer. J Reprod Med. 1998 Jun;43(6):541-6.

Reference Type: BACKGROUND

PMID: 9653702 (View on PubMed)

Oehninger S, Brzyski RG, Muasher SJ, Acosta AA, Jones GS. In-vitro fertilization and embryo transfer in patients with endometriosis: impact of a gonadotrophin releasing hormone agonist. Hum Reprod. 1989 Jul;4(5):541-4. doi: 10.1093/oxfordjournals.humrep.a136941.

Reference Type: BACKGROUND

PMID: 2507576 (View on PubMed)

Dicker D, Goldman GA, Ashkenazi J, Feldberg D, Voliovitz I, Goldman JA. The value of pre-treatment with gonadotrophin releasing hormone (GnRH) analogue in IVF-ET therapy of severe endometriosis. Hum Reprod. 1990 May;5(4):418-20. doi: 10.1093/oxfordjournals.humrep.a137114.

Reference Type: BACKGROUND

PMID: 2113929 (View on PubMed)

Dale PO, Tanbo T, Abyholm T. Endometriosis-associated infertility treated by long-term gonadotropin-releasing hormone agonist administration and assisted fertilization. J In Vitro Fert Embryo Transf. 1990 Jun;7(3):180-1. doi: 10.1007/BF01135686.

Reference Type: BACKGROUND

PMID: 2116489 (View on PubMed)

Nakamura K, Oosawa M, Kondou I, Inagaki S, Shibata H, Narita O, Suganuma N, Tomoda Y. Menotropin stimulation after prolonged gonadotropin releasing hormone agonist pretreatment for in vitro fertilization in patients with endometriosis. J Assist Reprod Genet. 1992 Apr;9(2):113-7. doi: 10.1007/BF01203749.

Reference Type: BACKGROUND

PMID: 1627925 (View on PubMed)

Curtis P, Jackson A, Bernard A, Shaw RW. Pretreatment with gonadotrophin releasing hormone (GnRH) analogue prior to in vitro fertilisation for patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 1993 Dec 30;52(3):211-6. doi: 10.1016/0028-2243(93)90074-m.

Reference Type: BACKGROUND

PMID: 8163038 (View on PubMed)

Marcus SF, Edwards RG. High rates of pregnancy after long-term down-regulation of women with severe endometriosis. Am J Obstet Gynecol. 1994 Sep;171(3):812-7. doi: 10.1016/0002-9378(94)90103-1.

Reference Type: BACKGROUND

PMID: 8092234 (View on PubMed)

Chedid S, Camus M, Smitz J, Van Steirteghem AC, Devroey P. Comparison among different ovarian stimulation regimens for assisted procreation procedures in patients with endometriosis. Hum Reprod. 1995 Sep;10(9):2406-11. doi: 10.1093/oxfordjournals.humrep.a136308.

Reference Type: BACKGROUND

PMID: 8530675 (View on PubMed)

Ruiz-Velasco V, Allende S. Goserelin followed by assisted reproduction: results in infertile women with endometriosis. Int J Fertil Womens Med. 1998 Jan-Feb;43(1):18-23.

Reference Type: BACKGROUND

PMID: 9532465 (View on PubMed)

Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006 Jan 25;2006(1):CD004635. doi: 10.1002/14651858.CD004635.pub2.

Reference Type: BACKGROUND

PMID: 16437491 (View on PubMed)

Other Identifiers

2010-022216-39

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ENDOFIV-010

Identifier Type: -

Identifier Source: org_study_id