Acupuncture for infertility: Is it an effective therapy?

  • Dong-mei Huang (黄冬梅)
  • Guang-ying Huang (黄光英)
  • Fu-er Lu (陆付耳)
  • Dieterle Stefan
  • Neuer Andreas
  • Greb Robert
Review

Abstract

Acupuncture has been used to treat infertility extensively, including ovulatory dysfunction, in vitro fertilization and embryo transfer (IVF-ET), and male infertility. This review summarizes the recent studies which investigated the role of acupuncture in infertility. In conclusion, most of the existing studies suggest a positive effect of acupuncture in infertility treatment. Firstly, acupuncture may improve ovulation by modulating the central and peripheral nervous systems, the neuroendocrine and endocrine systems, the ovarian blood flow, and metabolism. Secondly, acupuncture can improve the outcome of IVF-ET, and the mechanisms may be related to the increased uterine blood flow, inhibited uterine motility, and the anesis of depression, anxiety and stress. Its effect on modulating immune function also suggests helpfulness in improving the outcome of IVF-ET. Finally, the studies suggest that acupuncture plays a positive role in male infertility, the mechanism of which is not yet clear. Even though a positive effect of acupuncture in infertility has been found, well-designed multi-center, prospective randomized controlled studies are still needed to provide more reliable and valid scientific evidence. Furthermore, it is urgent and necessary to clarify the mechanism of acupuncture for infertility.

Keywords

acupuncture ovulation in vitro fertilization and embryo transfer infertility 

References

  1. 1.
    Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med 2001;9:2–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Burke A, Upchurch DM, Dye C, Chyu L. Acupuncture use in the United States: findings from the National Health Interview Survey. J Altern Complement Med 2006;12:639–648.PubMedCrossRefGoogle Scholar
  3. 3.
    NIH Consensus Development Panel of Acupuncture. Acupuncture. JAMA 1998;280:1518–1524.CrossRefGoogle Scholar
  4. 4.
    Stener-Victorin E, Wikland M, Waldenstrom U, Lundeberg T. Alternative treatments in reproductive medicine: much ado about nothing: acupuncture-a method of treatment in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of an effect. Hum Reprod 2002;17:1942–1946.PubMedCrossRefGoogle Scholar
  5. 5.
    Maciocia G, ed. Obstetrics and gynecology in Chinese medicine. London: Churchill Livingstone; 1998.Google Scholar
  6. 6.
    Lyttleton L, ed. Treatment of infertility with Chinese medicine. London: Churchill Livingstone; 2004.Google Scholar
  7. 7.
    Luo LL, ed. Sterility and infertility. 2nd ed. Beijing: People’s Medical Publishing House; 2009:469–497.Google Scholar
  8. 8.
    Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79:180–188.PubMedCrossRefGoogle Scholar
  9. 9.
    Chen BY, Yu J. Relationship between blood radioimmunoreactive beta-endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupunct Electrother Res 1991;16:1–5.PubMedGoogle Scholar
  10. 10.
    Mo X, Li D, Pu Y, Xi G, Le X, Fu Z. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med (Chin) 1993;13:115–119.Google Scholar
  11. 11.
    Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res 1997;22:97–108.PubMedGoogle Scholar
  12. 12.
    Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171–181.PubMedCrossRefGoogle Scholar
  13. 13.
    Cai XF. Substitution of acupuncture for HCG in ovulation induction. J Tradit Chin Med (Chin) 1997;17:119–121.Google Scholar
  14. 14.
    Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril 2002;78:1149–1153.PubMedCrossRefGoogle Scholar
  15. 15.
    Stener-Victorin E, Lundeberg T, Waldenstrom U, Bileviciute-Ljungar I, Janson PO. Effects of electroacupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries. Neuropeptides 2001;35:227–231.PubMedCrossRefGoogle Scholar
  16. 16.
    Stener-Victorin E, Lindholm C. Immunity and beta-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol Reprod 2004;70:329–333.PubMedCrossRefGoogle Scholar
  17. 17.
    Wang SJ, Zhu B, Jin ZG. Study on effects of electroacupuncture on the expression of GnRH in the rat at different estrous cycles. Chin Acupunt Moxib (Chin) 2007;27:273–278.Google Scholar
  18. 18.
    Aso T, Motohashi T, Murata M, Nishimura T, Kakizaki K. The influence of acupuncture stimulation on plasma levels of LH, FSH, progesterone and estradiol in normally ovulating women. Am J Chin Med 1976;4:391–401.PubMedCrossRefGoogle Scholar
  19. 19.
    Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih (Chin) 1989;9:199–202.Google Scholar
  20. 20.
    Knardahl S, Elam M, Olausson B, Wallin BG. Sympathetic nerve activity after acupuncture in humans. Pain 1998;75:19–25.PubMedCrossRefGoogle Scholar
  21. 21.
    Stener-Victorin E, Kobayashi R, Kurosawa M. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Auton Neurosci 2003;108:50–56.PubMedCrossRefGoogle Scholar
  22. 22.
    Stener-Victorin E, Fujisawa S, Kurosawa M. Ovarian blood flow responses to electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats. J Appl Physiol 2006;101:84–91.PubMedCrossRefGoogle Scholar
  23. 23.
    Stener-Victorin E, Kobayashi R, Watanabe O, Lundeberg T, Kurosawa M. Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetised rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol 2004;2:16.PubMedCrossRefGoogle Scholar
  24. 24.
    Stener-Victorin E, Lundeberg T, Cajander S, Aloe L, Manni L, Waldenstrom U, et al. Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod Biol Endocrinol 2003;1:33.PubMedCrossRefGoogle Scholar
  25. 25.
    Stener-Victorin E, Lundeberg T, Waldenström U, Bileviciute-Ljungar I, Janson PO. Effects of electro-acupuncture on corticotrophin releasing-factor (CRF) in rats with experimentally induced polycystic ovaries. Neuropeptides 2002;35:227–231.CrossRefGoogle Scholar
  26. 26.
    Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165–1174.PubMedCrossRefGoogle Scholar
  27. 27.
    Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165–169.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim SK, Lee G, Shin M, Han JB, Moon HJ, Park JH, et al. The association of serum leptin with the reduction of food intake and body weight during electroacupuncture in rats. Pharmacol Biochem Behav 2006;83:145–149.PubMedCrossRefGoogle Scholar
  29. 29.
    Manneräs L, Jonsdottir IH, Holmäng A, Lönn M, Stener-Victorin E. Low frequency electro-acupuncture and physical exercise improve metabolic disturbances and modulate gene expression in adipose tissue in rats with dihydrotestosterone-induced polycystic ovary syndrome. Endocrinology 2008;149:3559–3568.PubMedCrossRefGoogle Scholar
  30. 30.
    Lee M, Kim J, Lim H J, Shin B S. Effects of abdominal electroacupuncture on parameters related to obesity in obese women: a pilot study. Complement Ther Clin Pract 2006;12:97–100.PubMedCrossRefGoogle Scholar
  31. 31.
    Cabioglu MT, Ergene N. Electroacupuncture therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. Am J Chin Med 2005;33:525–533.PubMedCrossRefGoogle Scholar
  32. 32.
    Cabioglu MT, Ergene N. Changes in levels of serum insulin, C-peptide and glucose after electroacupuncture and diet therapy in obese women. Am J Chin Med 2006;34:367–376.PubMedCrossRefGoogle Scholar
  33. 33.
    Cabioglu MT, Ergene N. Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment. Am J Chin Med 2006;34:1–11.PubMedCrossRefGoogle Scholar
  34. 34.
    Luo HL, Li RH. Effect of electroacupuncture on leptin and adiponectin in simple obesity patients. Acupunt Res (Chin) 2007;32:264–267.Google Scholar
  35. 35.
    Holmang A, Mimura K, Lonnroth P. Involuntary leg movements affect interstitial nutrient gradients and blood flow in rat skeletal muscle. J Appl Physiol 2002;92:982–988.PubMedGoogle Scholar
  36. 36.
    Chang SL, Tsai CC, Lin JG, Hsieh CL, Lin RT, Cheng JT. Involvement of serotonin in the hypoglycemic response to 2 Hz electroacupuncture of Zusanli acupoint (ST36) in rats. Neurosci Lett 2005;379:69–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Chang SL, Lin KJ, Lin RT, Hung PH, Lin JG, Cheng JT. Enhanced insulin sensitivity using electroacupuncture on bilateral Zusanli acupoints (ST 36) in rats. Life Sci 2006;9:967–971.CrossRefGoogle Scholar
  38. 38.
    Li MY, Wei DY, Wu JM. Analysis on the interrelation between acupuncture-induced weight reduction and menstruation. Acupunt Res (Chin) 2007;32:142–144.Google Scholar
  39. 39.
    Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008;336:545–549.PubMedCrossRefGoogle Scholar
  40. 40.
    Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77:721–724.PubMedCrossRefGoogle Scholar
  41. 41.
    Paulus W, Zhang M, Strehler E, Seybold B, Sterzik K. Placebo-controlled trial of acupuncture effects in assisted reproductive therapy. Abstract of the 19th Annual Meeting of the ESHRE, Madrid, Spain, O-052 (2003).Google Scholar
  42. 42.
    Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006;85:1341–1346.PubMedCrossRefGoogle Scholar
  43. 43.
    Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 2006; 85:1347–1351.PubMedCrossRefGoogle Scholar
  44. 44.
    Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006;85:1352–1358.PubMedCrossRefGoogle Scholar
  45. 45.
    Benson MR, Elkind-Hirsch KE, Theall A, Fong K, Hogan RB, Scott RT, et al. Impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: a prospective single blind randomized study. Fertil Steril 2006;86(S3):s135.CrossRefGoogle Scholar
  46. 46.
    Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2008 Mar 1. [Epub ahead of print]Google Scholar
  47. 47.
    Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril 2008;90:1–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Stener-Victorin E, Waldenstrom U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electroacupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999;14:2480–2484.PubMedCrossRefGoogle Scholar
  49. 49.
    Stener-Victorin E, Waldenstrom U, Wikland M, Nilsson L, Hagglund L, Lundeberg T. Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid. Hum Reprod 2003;18:1454–1460.PubMedCrossRefGoogle Scholar
  50. 50.
    Humaidan P, Stener-Victorin E. Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique-an alternative to conventional analgesic methods. Hum Reprod 2004;19:1367–1372.PubMedCrossRefGoogle Scholar
  51. 51.
    Gejervall AL, Stener-Victorin E, Moller A, Janson PO, Werner C, Bergh C. Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients’ experiences of well-being after surgery. Hum Reprod 2005;20:728–735.PubMedCrossRefGoogle Scholar
  52. 52.
    Sator-Katzenschlager SM, Wolfler MM, Kozek-Langenecker SA, Sator K, Sator PG, Li B, et al. Auricular electroacupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment. Hum Reprod 2006;21:2114–2120.PubMedCrossRefGoogle Scholar
  53. 53.
    Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med 2007;13:38–48.PubMedGoogle Scholar
  54. 54.
    Balk J, Kalro B, Roberts JO. Electroacupuncture in infertile patients receiving in-vitro fertilization and embryo transfer: a pilot study. Med Acupunct 2003;14:12–14.Google Scholar
  55. 55.
    Lyttleton J. Treatment of infertility with Chinese medicine. London: Churchill Livingstone; 2004.Google Scholar
  56. 56.
    Humaidan P, Brock K, Bungum L, Stener-Victorin E. Pain relief during oocyte retrieval—exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online 2006;13:120–125.PubMedCrossRefGoogle Scholar
  57. 57.
    Craig LB, Criniti AR, Hansen KR, Marshall LA, Soules MR. Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertil Steril 2007;88 (S1):S40.CrossRefGoogle Scholar
  58. 58.
    Magarelli PC, Cridennda DK, Cohen M. Acupuncture: impact on eggs and embryos of IVF patients. Fertil Steril 2004;81 (S3):S9.Google Scholar
  59. 59.
    Magarelli PC, Cridennda DK. Acupuncture and IVF poor responders: a cure? Fertil Steril 2004;81(S3):S20.CrossRefGoogle Scholar
  60. 60.
    Magarelli PC, Cridennda DK, Cohen M. Acupuncture and good prognosis IVF patients: synergy. Fertil Steril 2004;82 (S2):S80.CrossRefGoogle Scholar
  61. 61.
    Lehl K, Pitzer L, Schoolcraft WB, Stevens JM. Elective acupuncture treatment pre and post embryo transfer: comparison of clinical pregnancy and implantation rates within age groups in recipients of donor oocyte. Fertil Steril 2006;86(S2):S340–S341.CrossRefGoogle Scholar
  62. 62.
    Teshima DRK, Nunes C, Chedid-grieco S. The effect of acupuncture in assisted reproduction techniques. Fertil Steril 2007;88(S1):S330.Google Scholar
  63. 63.
    Quintero R. A randomized, controlled, double-blind, crossover study evaluating acupuncture as an adjunct to IVF. Fertil Steril 2004;81(S3):S11–S 12.CrossRefGoogle Scholar
  64. 64.
    Wang WP, Check JH, Liss J, Choe JK. A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilizationembryo transfer. Fertil Steril 2005;83(S2):S24.CrossRefGoogle Scholar
  65. 65.
    Magarelli PC, Cridennda D, Cohen M. The demographics of acupunctures impact on IVF outcomes: Infertility Diagnosis and SART/CDC Age Groups. Fertil Steril 2007;87(S2):S10.CrossRefGoogle Scholar
  66. 66.
    Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, et al. The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril 1992;57:372–376.PubMedGoogle Scholar
  67. 67.
    Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996;11:1314.PubMedGoogle Scholar
  68. 68.
    Kim J, Shin KH, Na SC. Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000;50:225–230.PubMedCrossRefGoogle Scholar
  69. 69.
    Fanchin R, Righini C, Olivennes F, Taylor S, de Ziegler D, Frydman R. Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization. Hum Reprod 1998;13:1968–1974.PubMedCrossRefGoogle Scholar
  70. 70.
    Csemiczky GLB, Collins A. The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment. Acta Obstet Gynecol Scand 2000;79:113–118.PubMedCrossRefGoogle Scholar
  71. 71.
    Demyttenaere K, Bonte L, Gheldof M, Vervaeke M, Meuleman C, Vanderschuerem D, et al. Coping style and depression level influence outcome in fertilization. Fertil Steril 1998;69:1026–1033.PubMedCrossRefGoogle Scholar
  72. 72.
    Thiering P, Beaurepaire J, Jones M, Saunders D, Tennant C. Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology. J Psychosom Res 1993;37:481–491.PubMedCrossRefGoogle Scholar
  73. 73.
    Dong JT. Research on the reduction of anxiety and depression with acupuncture. Am J Acupunct 1993;21:327–330.Google Scholar
  74. 74.
    Luo H, Meng F, Jia Y, Zhao X. Clinical research on the therapeutic effect of the electroacupuncture treatment in patients with depression. Clin Neurosi 1998;52:338–340.Google Scholar
  75. 75.
    Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med 2001;110:481–485.PubMedCrossRefGoogle Scholar
  76. 76.
    Han JS. Acupuncture and endorphins. Neurosci Lett 2004;361:258–261.PubMedCrossRefGoogle Scholar
  77. 77.
    Wang JD, Kuo TB, Yang CC. An alternative method to enhance vagal activities and suppress sympathetic activities in humans. Auton Neurosci 2002;100:90–95.PubMedCrossRefGoogle Scholar
  78. 78.
    Cabioğlu MT, Cetin BE. Acupuncture and immunomodulation. Am J Chin Med 2008;36:25–36.PubMedCrossRefGoogle Scholar
  79. 79.
    McLachlan R, de Krester D. Male infertility: the case for continued research. MJA 2001;174:116–117.PubMedGoogle Scholar
  80. 80.
    Oldereid NB, Rui H, Purvis K. Male partners in infertile couples. Personal attitudes and contact with the Norwegian health service. Scand J Soc Med 1990;18:207–211.PubMedGoogle Scholar
  81. 81.
    Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl 1997;39:155–161.PubMedCrossRefGoogle Scholar
  82. 82.
    Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia 2000;32:31–39.PubMedGoogle Scholar
  83. 83.
    Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci (Chin) 2002;22:228–230.CrossRefGoogle Scholar
  84. 84.
    Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril 2005;84:141–147.PubMedCrossRefGoogle Scholar
  85. 85.
    He XY. Acupuncture plus medication for male idiopathic oligospermatic sterility. Shanghai J Acupunct Moxib (Chin) 1998;5:21–22.Google Scholar
  86. 86.
    Gurfinkel E, Cedenho AP, Yamamura Y, Srougi M. Effects of acupuncture and moxa treatment in patients with semen abnormalities. Asian J Androl 2003;5:345–348.PubMedGoogle Scholar
  87. 87.
    Gerhard I, Jung I, Postneek F. Effects of acupuncture on semen parameters/hormone profile in infertile men. Mol Androl 1992;4:9–24.Google Scholar
  88. 88.
    Dieterle S, Li CF, Greb R, Bartzsch F, Hatzmann W, Huang DM. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil Steril 2009;92:1340–1343.PubMedCrossRefGoogle Scholar
  89. 89.
    Dong C, Chen SR, Jiang J, Xiao YH, Cai MX, Zhang YJ, Clinical observation and study of mechanisms of needlepicking therapy for primary infertility of abnormal sperm. Chin Acupunt Moxib (Chin) 2006;26:389–391.Google Scholar
  90. 90.
    Fu B, Lun X, Gong Y. Effects of the combined therapy of acupuncture with herbal drugs on male immune infertility-a clinical report of 50 cases. J Tradit Chin Med (Chin) 2005;25:186–189.Google Scholar

Copyright information

© Chinese Association of the Integration of Traditional and Western Medicine and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Dong-mei Huang (黄冬梅)
    • 1
  • Guang-ying Huang (黄光英)
    • 1
  • Fu-er Lu (陆付耳)
    • 1
  • Dieterle Stefan
    • 2
    • 3
  • Neuer Andreas
    • 3
  • Greb Robert
    • 3
  1. 1.Institute of Integrated Traditional Chinese and Western Medicine, Tongji HospitalHuazhong University of Science and TechnologyWuhanChina
  2. 2.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynaecologyUniversity of Witten/HerdeckeDortmundGermany
  3. 3.Infertility Center of DortmundDortmundGermany

Personalised recommendations