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Mackens S, Mostinckx L, Drakopoulos P, Segers I, Santos-Ribeiro S, Popovic-Todorovic B, Tournaye H, Blockeel C, De Vos M. Early pregnancy loss in patients with polycystic ovary syndrome after IVM versus standard ovarian stimulation for IVF/ICSI. Hum Reprod 2021; 35:2763-2773. [PMID: 33025015 DOI: 10.1093/humrep/deaa200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Is the incidence of early pregnancy loss (EPL) in patients with polycystic ovary syndrome (PCOS) higher after IVM of oocytes than after ovarian stimulation (OS) for IVF/ICSI? SUMMARY ANSWER Women with PCOS who are pregnant after fresh embryo transfer have a higher probability of EPL following IVM, but after frozen embryo transfer (FET), no significant difference in the incidence of EPL was observed following IVM compared to OS. WHAT IS KNOWN ALREADY There is conflicting evidence in the current literature with regard to the risk of EPL after IVM of oocytes when compared with OS. Because of the limited sample size in previous studies, the use of different IVM systems and the possible bias introduced by patient characteristics and treatment type, firm conclusions cannot be drawn. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study evaluating 800 women, with a diagnosis of infertility and PCOS as defined by Rotterdam criteria, who had a first positive pregnancy test after fresh or FET following IVM or OS between January 2010 and December 2017 in a tertiary care academic medical centre. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancies after non-hCG triggered IVM following a short course of highly purified human menopausal gonadotropin were compared with those after conventional OS. The primary outcome was EPL, defined as a spontaneous pregnancy loss before 10 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE In total, 329 patients with a positive pregnancy test after IVM and 471 patients with a positive pregnancy test after OS were included. Women who were pregnant after IVM were younger (28.6 ± 3.4 years vs 29.3 ± 3.6 years, P = 0.005) and had higher serum anti-Mullerian hormone levels (11.5 ± 8.1 ng/ml vs 7.2 ± 4.1 ng/ml, P < 0.001) compared to those who were pregnant after OS. The distribution of PCOS phenotypes was significantly different among women in the IVM group compared to those in the OS group and women who were pregnant after OS had previously suffered EPL more often (28% vs 17.6%, P = 0.003). EPL was significantly higher after fresh embryo transfer following IVM compared to OS (57/122 (46.7%) vs 53/305 (17.4%), P < 0.001), while the results were comparable after FET (63/207 (30.4%) vs 60/166 (36.1%), respectively, P = 0.24). In the multivariate logistic regression analysis evaluating fresh embryo transfer cycles, IVM was the only independent factor (adjusted odds ratio (aOR) 4.24, 95% CI 2.44-7.37, P < 0.001)) significantly associated with increased odds of EPL. On the other hand, when the same model was applied to FET cycles, the type of treatment (IVM vs OS) was not significantly associated with EPL (aOR 0.73, 95% CI 0.43-1.25, P = 0.25). LIMITATIONS, REASONS FOR CAUTION The current data are limited by the retrospective nature of the study and the potential of bias due to unmeasured confounders. WIDER IMPLICATIONS OF THE FINDINGS The increased risk of EPL after fresh embryo transfer following IVM may point towards inadequate endometrial development in IVM cycles. Adopting a freeze-all strategy after IVM seems more appropriate. Future studies are needed to ascertain the underlying cause of this observation. STUDY FUNDING/COMPETING INTEREST(S) The Clinical IVM research has been supported by research grants from Cook Medical and Besins Healthcare. All authors declared no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Mackens
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - L Mostinckx
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - P Drakopoulos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Department of Obstetrics and Gynecology, Crete University, Crete, Greece
| | - I Segers
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | | | | | - H Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - C Blockeel
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Department of Obstetrics and Gynaecology, University of Zagreb-School of Medicine, Zagreb, Croatia
| | - M De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
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Song SY, Yang JB, Song MS, Oh HY, Lee GW, Lee M, Ko YB, Lee KH, Chang HK, Kwak SM, Yoo HJ. Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: a meta-analysis. Arch Gynecol Obstet 2019; 300:737-750. [PMID: 31172307 DOI: 10.1007/s00404-019-05210-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/31/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effect of pretreatment with combined oral contraceptives (COC) on outcomes in women with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology for subfertility. METHODS Two authors independently searched MEDLINE, EMBASE, and the Cochran Library to identify and review articles published from October 1995 until December 2018 according to selection criteria. Outcomes are expressed as mean difference and odds ratio (OR) in a meta-analysis model. RESULTS A total of seven studies were included in this meta-analysis: one randomized controlled study and two prospective and four retrospective cohort studies. Meta-analysis showed that the COC pretreatment did not affect rate of clinical pregnancy (OR = 0.93, 95% confidence interval CI 0.65-1.34, I2 = 76%) or ovarian hyperstimulation syndrome (OR = 0.90, 95% CI 0.57-1.44, I2 = 0%). However, the rate of miscarriage in the COC group was significantly higher (OR = 1.33, 95% CI 1.02-1.72, I2 = 9%) and the rate of cumulative live birth was significantly lower compared with the control group (OR = 0.72, 95% CI 0.54-0.98, I2 = 55%). Subgroup analysis showed higher rates of miscarriage and lower rates of cumulative live birth in studies with a gonadotropin-releasing hormone (GnRH) antagonist protocol (OR = 1.69, 95% CI 1.17-2.44, I2 = 0% and OR = 0.38, 95% CI 0.29-0.50, respectively). CONCLUSION Pretreatment with COC in women with PCOS before assisted reproductive technology may have an adverse effect on clinical outcomes, especially with a GnRH antagonist protocol.
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Affiliation(s)
- Soo Youn Song
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jung Bo Yang
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Min Soon Song
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hye Young Oh
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Geon Woo Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Mina Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Young Bok Ko
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ki Hwan Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.,Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ha Kyun Chang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang Mi Kwak
- Total Healthcare Center, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea. .,Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Karavani G, Schachter-Safrai N, Revel A, Mordechai-Daniel T, Bauman D, Imbar T. In vitro maturation rates in young premenarche patients. Fertil Steril 2019; 112:315-322. [PMID: 31056316 DOI: 10.1016/j.fertnstert.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/11/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate in vitro maturation (IVM) efficacy and oocyte retrieval rates after ovarian tissue cryopreservation in young premenarche girls facing chemo- and radiotherapy. DESIGN A retrospective cohort study. SETTING University-affiliated tertiary medical center. PATIENT(S) A total of 84 chemotherapy-naïve patients ages 0-18 years referred for fertility preservation between 2004 and 2017: 33 premenarche and 51 postmenarche patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) IVM in the pre- and postmenarche groups and in the subgroups of very young (up to age 5 years) and older (5-10 years) premenarche girls. RESULTS The number of oocytes retrieved did not significantly differ between the postmenarche and premenarche groups (10.8 ± 8.5 and 8.1 ± 6.8, respectively). However, the overall IVM rate was significantly higher in the postmenarche group (28.2% vs. 15.5%, respectively; odds ratio = 0.47). A separate analysis for patients up to 5 years of age demonstrated significantly lower oocyte yield compared with the older (5-10 years) premenarche girls (4.7 ± 5.2 vs.10.3 ± 7.0 oocytes, respectively) and much lower IVM rates (4.9% and 18.2%, respectively). Correlation of age with number of retrieved and matured oocytes showed a positive significant correlation (r = 0.45 and r = 0.64, respectively). CONCLUSIONS IVM performed after ovarian tissue cryopreservation in premenarche girls and specifically in very young girls (4 years and younger) yields substantially decreased maturation rates compared with postmenarche patients, raising a question as to the utility of current IVM technique in this age group. Further studies are required to assess modification of the IVM technique for young girls.
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Affiliation(s)
- Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Natali Schachter-Safrai
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel Revel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Fertility Preservation Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Talya Mordechai-Daniel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Fertility Preservation Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dvora Bauman
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Imbar
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Fertility Preservation Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Hatırnaz Ş, Ata B, Hatırnaz ES, Dahan MH, Tannus S, Tan J, Tan SL. Oocyte in vitro maturation: A sytematic review. Turk J Obstet Gynecol 2018; 15:112-125. [PMID: 29971189 PMCID: PMC6022428 DOI: 10.4274/tjod.23911] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023] Open
Abstract
In vitro maturation (IVM) is one of the most controversial aspects of assisted reproductive technology. Although it has been studied extensively, it is still not a conventional treatment option and is accepted as an alternative treatment. However, studies have shown that IVM can be used in almost all areas where in vitro fertilization (IVF) is used and it has a strong place in fertility protection and Ovarian Hyperstimulation syndrome management. The aim of this systematic review was to address all aspects of the current knowledge of IVM treatment together with the evolution of IVM and IVF.
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Affiliation(s)
- Şafak Hatırnaz
- Medicana International Hospital, In Vitro Fertilization Center, Samsun, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, In Vitro Fertilization Center, İstanbul, Turkey
| | | | - Michael Haim Dahan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Samer Tannus
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Justin Tan
- Mc Gill University Faculty of Medicine, Department of Obstetrics and Gynecology, Quebec, Canada
| | - Seang Lin Tan
- Originelle Women and Reproductive Medicine Center, Clinic of Obstetrics and Gynecology, Montreal, Quebec, Canada
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Ben-Haroush A, Abir R, Sapir O, Garor R, Fisch B. Aspiration of immature oocytes during cesarean section for fertility preservation. J Matern Fetal Neonatal Med 2017; 30:2112-2114. [PMID: 27649578 DOI: 10.1080/14767058.2016.1238895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In vitro maturation (IVM) of immature oocytes is an important technology for selected clinical indications. We previously described a pregnant woman with a history of renal transplantation who underwent oocyte aspiration during cesarean section (CS) for fertility preservation and future surrogacy. CASE A 27-year-old pregnant woman was diagnosed with neck rhabdomyosarcoma at 37 weeks' gestation. CS was performed with direct aspiration of small follicles from one ovary and oophorectomy of the other. Twenty-one identified oocyte-cumulus complexes were cultured, and 12 mature oocytes and 14 ovarian cortex strips were cryopreserved. CONCLUSION Aspirating competent oocytes during CS may serve as an additional means of fertility preservation in pregnant women. The procedure may also be offered to patients with an IVF pregnancy who are scheduled for elective CS.
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Affiliation(s)
- Avi Ben-Haroush
- a Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center -- Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Ronit Abir
- a Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center -- Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Onit Sapir
- a Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center -- Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Roni Garor
- a Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center -- Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Benjamin Fisch
- a Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center -- Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Abir R, Ben-Aharon I, Garor R, Yaniv I, Ash S, Stemmer SM, Ben-Haroush A, Freud E, Kravarusic D, Sapir O, Fisch B. Cryopreservation of in vitro matured oocytes in addition to ovarian tissue freezing for fertility preservation in paediatric female cancer patients before and after cancer therapy. Hum Reprod 2016; 31:750-62. [PMID: 26848188 DOI: 10.1093/humrep/dew007] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/11/2016] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is a protocol that combines in vitro maturation of germinal vesicle-stage oocytes and their vitrification with freezing of cortical ovarian tissue feasible for use in fertility preservation for both chemotherapy-naive paediatric patients as well as patients after initiation of cancer therapy? SUMMARY ANSWER Follicle-containing ovarian tissue as well as oocytes that can undergo maturation in vitro can be obtained from paediatric patients (including prepubertal girls) both before and after cancer therapy. WHAT IS KNOWN ALREADY Anticancer therapy reduces the number of follicles/oocytes but this effect is less severe in young patients, particularly the paediatric age group. Autotransplantation of ovarian tissue has yielded to date 60 live births, including one from tissue that was cryostored in adolescence. However, it is assumed that autografting cryopreserved-thawed ovarian cortical tissue poses a risk of reseeding the malignancy. Immature oocytes can be collected from very young girls without hormonal stimulation and then matured in vitro and vitrified. We have previously shown that there is no difference in the number of ovarian cortical follicles between paediatric patients before and after chemotherapy. STUDY DESIGN, SIZE, DURATION A prospective study was conducted in a cohort of 42 paediatric females with cancer (before and after therapy initiation) who underwent fertility preservation procedures in 2007-2014 at a single tertiary medical centre. PARTICIPANTS/MATERIALS, SETTING, METHODS The study group included girls and adolescent females with cancer: 22 before and 20 after chemotherapy. Following partial or complete oophorectomy, immature oocytes were either aspirated manually ex vivo from visible small antral follicles or filtered from spent media. Oocytes were incubated in oocyte maturation medium, and those that matured at 24 or 48 h were vitrified. Ovarian cortical tissue was cut and prepared for slow-gradual cryopreservation. Anti-Mullerian hormone (AMH) levels were measured in serum before and after oophorectomy. MAIN RESULTS AND ROLE OF CHANCE Ovarian tissue was successfully collected from 78.7% of the 42 patients. Oocytes were obtained from 20 patients before chemotherapy and 13 after chemotherapy. The youngest patients from whom oocytes were retrieved were aged 2 years (two atretic follicles) and 3 years. Of the 395 oocytes collected, ∼30% were atretic (29.6% in the pre-chemotherapy group, 37% in the post-chemotherapy group). One hundred twenty-one oocytes (31%) were matured in vitro and vitrified: 67.8% from patients before chemotherapy, the rest after chemotherapy. Mature oocytes suitable for vitrification were obtained from 16/20 patients before chemotherapy and from 12/13 patients after chemotherapy (maturation rate, 32 and 26.4%, respectively). There were significant correlations of the number of vitrified oocytes with patient age (more matured oocytes with older age) (P = 0.001) and with pre-oophorectomy AMH levels (P = 0.038 pre-chemotherapy group, P = 0.029 post-chemotherapy group). Oocytes suitable for vitrification were obtained both by manual aspiration of antral follicles (45%) and from rinse solutions after dissection. There were significantly more matured oocytes in the pre-chemotherapy group from aspiration than in the post-chemotherapy group after both aspiration (P < 0.033) and retrieval from rinsing fluids (P < 0.044). The number of pre-antral follicles per histological section did not differ in the pre- versus post-chemotherapy. AMH levels dropped by approximately 50% after ovarian removal in both groups, with a significant correlation between pre- and post-oophorectomy levels (P = 0.002 pre-chemotherapy group, P = 0.001 post-chemotherapy group). LIMITATIONS, REASONS FOR CAUTION There were no patients between 5 years and 10 years old in the post-chemotherapy group, which might have affected some results and correlations. Oocytes from patients soon after chemotherapy might be damaged, and caution is advised when using them for fertility-restoration purposes. The viability, development capability and fertilization potential of oocytes from paediatric patients, especially prepubertal and after chemotherapy, are unknown, in particular oocytes recovered from the media after the tissue dissection step. WIDER IMPLICATIONS OF THE FINDINGS Although more oocytes were collected and matured from chemotherapy-naïve paediatric patients, ovarian tissue and immature oocytes were also retrieved from young girls in whom cancer therapy has already been initiated. Our centre has established a protocol for potential maximal fertility preservation in paediatric female patients with cancer. Vitrified-in vitro-matured oocytes may serve as an important gamete source in paediatric female patients with cancer because the risk of reseeding the disease is avoided. Further studies are needed on the fertility-restoring potential of oocytes from paediatric and prepubertal patients, especially after exposure to chemotherapy. STUDY FUNDING/COMPETING INTERESTS The study was conducted as part of the routine procedures for fertility preservation at our IVF unit. No funding outside of the IVF laboratory was received. Funding for the AMH measurements was obtained by a research grant from the Israel Science Foundation (to B.-A.I., ISF 13-1873). None of the authors have competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Abir
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - I Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - R Garor
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - I Yaniv
- Department of Paediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Paediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - E Freud
- Department of Paediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Paediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Sapir
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
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