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Original Article07-01-2001
Bacterial Vaginosis In Menopausal Women and in Women with Infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):641-646
Abstract
Original ArticleBacterial Vaginosis In Menopausal Women and in Women with Infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):641-646
DOI 10.1590/S0100-72032001001000005
Views124See morePurpose: to evaluate the prevalence of bacterial vaginosis (BV) in menopausal and in infertile outpatients and to analyze the current clinical diagnostic methods. Methods: we evaluated retrospectively 104 menopausal women and 86 with infertility. Characteristic vaginal discharge on gynecological examination, pH >4.5, positive KOH whiff test, and bacterial vaginosis by Gram test were considered positive. BV was established when at least 3 out of 4 criteria were found. Results: among the menopausal women, 29 patients (28.1%) were clinically positive for BV, 10 (9.6%) had positive whiff test, 68 (65.4%) vaginal pH >4.5, and 34 (32.7%) positive Gram test. For the infertile patients the figures were 20 (23.2%), 13 (15.1%), 61 (70.9%) and 26 (30.2%), respectively. According to our established criteria, BV was diagnosed in 14 menopausal (13.5%) and 15 infertile (17.4%) women. Conclusion: bacterial vaginosis prevalence was similar in both groups of patients. In addition, all diagnostic criteria should be followed in order to avoid underdiagnosing this pathology or treating an otherwise normal vaginal flora.
Views124
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleBacterial Vaginosis In Menopausal Women and in Women with Infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):641-646
DOI 10.1590/S0100-72032001001000005
Views124See morePurpose: to evaluate the prevalence of bacterial vaginosis (BV) in menopausal and in infertile outpatients and to analyze the current clinical diagnostic methods. Methods: we evaluated retrospectively 104 menopausal women and 86 with infertility. Characteristic vaginal discharge on gynecological examination, pH >4.5, positive KOH whiff test, and bacterial vaginosis by Gram test were considered positive. BV was established when at least 3 out of 4 criteria were found. Results: among the menopausal women, 29 patients (28.1%) were clinically positive for BV, 10 (9.6%) had positive whiff test, 68 (65.4%) vaginal pH >4.5, and 34 (32.7%) positive Gram test. For the infertile patients the figures were 20 (23.2%), 13 (15.1%), 61 (70.9%) and 26 (30.2%), respectively. According to our established criteria, BV was diagnosed in 14 menopausal (13.5%) and 15 infertile (17.4%) women. Conclusion: bacterial vaginosis prevalence was similar in both groups of patients. In addition, all diagnostic criteria should be followed in order to avoid underdiagnosing this pathology or treating an otherwise normal vaginal flora.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article07-01-2001
Conservative Surgical Treatment of Hydrosalpinx: Laparoscopy or Microsurgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):627-631
Abstract
Original ArticleConservative Surgical Treatment of Hydrosalpinx: Laparoscopy or Microsurgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):627-631
DOI 10.1590/S0100-72032001001000003
Views109See morePurpose: to analyze the pregnancy rates after laparoscopic and microsurgical treatment of hydrosalpinx. Methods: from July 1996 to May 1999 thirty-nine infertile patients with hydrosalpinx were treated according to a previously approved research protocol. They were randomly divided into two groups, according to the previously proposed surgical approach: laparoscopic or open microsurgical salpingostomy. To analyze the results, patients were stratified according to tubal damage, and pregnancy rates in both groups were determined for 24 months. Results: pregnancy rates in our series were 35.3 and 33.3% after laparoscopic and microsurgical salpingostomy, respectively. According to the severity of tubal damage, patients with mildly and moderately damaged tubes got pregnant in 66.7 and 21.7% of the cases, respectively. Cumulative pregnancy rates in one and two years were 25.0 and 34.4%, respectively. There was a single case of ectopic pregnancy, corresponding to 9.1% of all pregnancies. Conclusion: patients with mild and moderate lesions may be initially treated with surgery, and conception success is inversely proportional to the degree of tubal damage.
Views109This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleConservative Surgical Treatment of Hydrosalpinx: Laparoscopy or Microsurgery?
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(10):627-631
DOI 10.1590/S0100-72032001001000003
Views109See morePurpose: to analyze the pregnancy rates after laparoscopic and microsurgical treatment of hydrosalpinx. Methods: from July 1996 to May 1999 thirty-nine infertile patients with hydrosalpinx were treated according to a previously approved research protocol. They were randomly divided into two groups, according to the previously proposed surgical approach: laparoscopic or open microsurgical salpingostomy. To analyze the results, patients were stratified according to tubal damage, and pregnancy rates in both groups were determined for 24 months. Results: pregnancy rates in our series were 35.3 and 33.3% after laparoscopic and microsurgical salpingostomy, respectively. According to the severity of tubal damage, patients with mildly and moderately damaged tubes got pregnant in 66.7 and 21.7% of the cases, respectively. Cumulative pregnancy rates in one and two years were 25.0 and 34.4%, respectively. There was a single case of ectopic pregnancy, corresponding to 9.1% of all pregnancies. Conclusion: patients with mild and moderate lesions may be initially treated with surgery, and conception success is inversely proportional to the degree of tubal damage.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Report06-26-2001
Endometrial osseous metaplasia and primary infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):119-121
Abstract
Case ReportEndometrial osseous metaplasia and primary infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):119-121
DOI 10.1590/S0100-72032001000200010
Views75See moreEndometrial metaplastic ossification is a rare condition and can be partially explained by a neoformation in the endometrium, with calcium deposition. However, a common situation is the previous history of abortion with persistence of ossicles in the uterine cavity. The endometrial ossification was reported in a 31-year-old woman, without previous pregnancy or history of abortion. This patient presented dysmenorrhea and infertility. Pelvic ultrasonography showed a hyperechoic area in the uterine fundus. Histeroscopy was performed and an image suggestive of bone was seen. This tissue was removed by histeroscopy and the histopathological analysis confirmed endometrial ossification.
Views75This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Case ReportEndometrial osseous metaplasia and primary infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):119-121
DOI 10.1590/S0100-72032001000200010
Views75See moreEndometrial metaplastic ossification is a rare condition and can be partially explained by a neoformation in the endometrium, with calcium deposition. However, a common situation is the previous history of abortion with persistence of ossicles in the uterine cavity. The endometrial ossification was reported in a 31-year-old woman, without previous pregnancy or history of abortion. This patient presented dysmenorrhea and infertility. Pelvic ultrasonography showed a hyperechoic area in the uterine fundus. Histeroscopy was performed and an image suggestive of bone was seen. This tissue was removed by histeroscopy and the histopathological analysis confirmed endometrial ossification.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-25-2001
Embryo Culture to Blastocyst Stage: Comparison Using Sequential Medium and Coculture
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):589-595
Abstract
Original ArticleEmbryo Culture to Blastocyst Stage: Comparison Using Sequential Medium and Coculture
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):589-595
DOI 10.1590/S0100-72032001000900007
Views110See morePurpose: to compare the embryonic development obtained with two different culture methods (sequential medium or coculture in Vero cells). Methods: oocytes were recovered from 110 patients and submitted toin vitro fertilization. The embryos of half of the patients were co-cultured with Vero cells and the embryos of the other half were cultured in sequential G1:2/G2:2 medium for five days. The embryos were transferred on the 5th day after fertilization after morphological evaluation for the determination of blastula formation rate. Pregnancy was defined by ultrasonography and a fetal heartbeat was determined 13 weeks after transfer. Results: the expanded blastocyst rate found in our study was 15.9 and 14% with Vero cells and G1:2/G2:2, respectively. With Vero cells 36.0% of patients became pregnant and the implantation rate was 18.9%. When G1:2/G2:2 was used, the pregnancy and implantation rates were 28.9 and 14.9%, respectively. Only 17 patients had blastocysts after coculture in Vero cells, with a 76.5% pregnancy rate and a 63.5% implantation rate. When embryos were cultured in G1/G2, 21 patients presented blastocysts and the pregnancy and implantation rates were 57.1 and 76.0%, respectively. Conclusion: there was no significant difference in pregnancy or implantation rates between the 2 types of culture. When expanded blastocysts were transferred, the implantation and pregnancy rats increased with both culture types. In these patients, regardless of the type of culture used, a larger number of oocytes was obtained, suggesting that the implantation and pregnancy rates are affected not only by the culture conditions but also by the quality of the eggs, since "good responders" had better results.
Views110This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleEmbryo Culture to Blastocyst Stage: Comparison Using Sequential Medium and Coculture
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):589-595
DOI 10.1590/S0100-72032001000900007
Views110See morePurpose: to compare the embryonic development obtained with two different culture methods (sequential medium or coculture in Vero cells). Methods: oocytes were recovered from 110 patients and submitted toin vitro fertilization. The embryos of half of the patients were co-cultured with Vero cells and the embryos of the other half were cultured in sequential G1:2/G2:2 medium for five days. The embryos were transferred on the 5th day after fertilization after morphological evaluation for the determination of blastula formation rate. Pregnancy was defined by ultrasonography and a fetal heartbeat was determined 13 weeks after transfer. Results: the expanded blastocyst rate found in our study was 15.9 and 14% with Vero cells and G1:2/G2:2, respectively. With Vero cells 36.0% of patients became pregnant and the implantation rate was 18.9%. When G1:2/G2:2 was used, the pregnancy and implantation rates were 28.9 and 14.9%, respectively. Only 17 patients had blastocysts after coculture in Vero cells, with a 76.5% pregnancy rate and a 63.5% implantation rate. When embryos were cultured in G1/G2, 21 patients presented blastocysts and the pregnancy and implantation rates were 57.1 and 76.0%, respectively. Conclusion: there was no significant difference in pregnancy or implantation rates between the 2 types of culture. When expanded blastocysts were transferred, the implantation and pregnancy rats increased with both culture types. In these patients, regardless of the type of culture used, a larger number of oocytes was obtained, suggesting that the implantation and pregnancy rates are affected not only by the culture conditions but also by the quality of the eggs, since "good responders" had better results.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-25-2001
Follow-up of women who sought sterilization reversal at a public infertility clinic
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):69-73
Abstract
Original ArticleFollow-up of women who sought sterilization reversal at a public infertility clinic
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):69-73
DOI 10.1590/S0100-72032001000200002
Views76See morePurpose: to analyze the follow-up of regretful sterilized women who sought sterilization reversal at a public service. Method: a retrospective study was carried out with a population of sterilized women who attended the infertility clinic during the period from June 1983 to July 1998. The analysis of the data was descriptive. Results: among the 147 women who sought the infertility clinic, most were 20 to 30 years old and 60% were sterilized at the age of 25 years. During follow-up, 54.4% of the initial patients gave up treatment, 15% were discouraged to continue the investigation and only 31 (21%) underwent tubal anastomosis. Fourteen women became pregnant and nine (6.1%) of them had term gestation. Conclusion: women who request sterilization should be counseled and instructed about the definitive feature of this method in order to reduce regret after sterilization.
Views76This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleFollow-up of women who sought sterilization reversal at a public infertility clinic
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):69-73
DOI 10.1590/S0100-72032001000200002
Views76See morePurpose: to analyze the follow-up of regretful sterilized women who sought sterilization reversal at a public service. Method: a retrospective study was carried out with a population of sterilized women who attended the infertility clinic during the period from June 1983 to July 1998. The analysis of the data was descriptive. Results: among the 147 women who sought the infertility clinic, most were 20 to 30 years old and 60% were sterilized at the age of 25 years. During follow-up, 54.4% of the initial patients gave up treatment, 15% were discouraged to continue the investigation and only 31 (21%) underwent tubal anastomosis. Fourteen women became pregnant and nine (6.1%) of them had term gestation. Conclusion: women who request sterilization should be counseled and instructed about the definitive feature of this method in order to reduce regret after sterilization.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-24-2001
Hysterosalpingo-contrast Sonography in the Study of Tubal Patency in Infertile Women
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):491-495
Abstract
Original ArticleHysterosalpingo-contrast Sonography in the Study of Tubal Patency in Infertile Women
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Views87See morePurpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
Views87This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleHysterosalpingo-contrast Sonography in the Study of Tubal Patency in Infertile Women
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Views87See morePurpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article09-23-2002
Outcome of Assisted Reproduction Treatment in Patients with Previous Ovarian Surgery for Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
Abstract
Original ArticleOutcome of Assisted Reproduction Treatment in Patients with Previous Ovarian Surgery for Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Views74See morePurpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Views74This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleOutcome of Assisted Reproduction Treatment in Patients with Previous Ovarian Surgery for Endometriosis
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Views74See morePurpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article07-24-2002
Laparoscopic Tubal Anastomosis: Preliminary Results
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):337-341
Abstract
Original ArticleLaparoscopic Tubal Anastomosis: Preliminary Results
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):337-341
DOI 10.1590/S0100-72032002000500008
Views63See morePurpose: to evaluate pregnancy outcome after laparoscopic tubal anastomosis. Method: from December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age ranged from 28 to 37 years. The follow-up period ranged from 150 to 425 days and tubal patency (evaluated by hysterosalpingography) and pregnancy outcome were evaluated. Results: laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was attempted in all except two patients. The operation time ranged from 95 to 155 minutes and all patients were discharged on the following morning. Tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. Nine patients got pregnant in up to four months and four in up to nine months after discontinuing the use of condom. Conclusion: in selected cases, laparoscopic tubal reversal can be performed in patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.
Views63This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleLaparoscopic Tubal Anastomosis: Preliminary Results
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):337-341
DOI 10.1590/S0100-72032002000500008
Views63See morePurpose: to evaluate pregnancy outcome after laparoscopic tubal anastomosis. Method: from December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age ranged from 28 to 37 years. The follow-up period ranged from 150 to 425 days and tubal patency (evaluated by hysterosalpingography) and pregnancy outcome were evaluated. Results: laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was attempted in all except two patients. The operation time ranged from 95 to 155 minutes and all patients were discharged on the following morning. Tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. Nine patients got pregnant in up to four months and four in up to nine months after discontinuing the use of condom. Conclusion: in selected cases, laparoscopic tubal reversal can be performed in patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Infertility Archives - Revista Brasileira de Ginecologia e Obstetrícia
