The power of completely focusing on the task at hand also applies to eating. Eating should be a sacred time, a time to connect with yourself, your body and the very means of your nourishment — your food, so you can get the most out of it for the ultimate benefit of your reproductive health and prospective child. This might sound way over the top but it actually makes a whole lot of sense. Isn’t it true that when you are not focused on a task and are distracted by your surroundings, no matter how hard you try, you will not complete the task as well as if you are totally focused? Why do you think that when it comes to eating and getting the most benefit from your food this principle would not apply?
Here’s a little revision, and some great tips, to help you digest and assimilate your food more completely and make better building blocks for healthy sex cells, which eventually could create a perfectly well- formed, balanced and healthy little person.
- Avoid distractions while eating e.g. watching TV or reading magazines and newspapers — you will tend to eat more than you actually need;
- Avoid drinking with your meals because it dilutes stomach acid and digestive enzymes;
- Chew your food really well;
- Eat every 3 hours;
- Never skip breakfast;
- Avoid soy, gluten and dairy;
- Avoid processed, packaged and dead foods;
- Avoid fried foods;
- Finish eating at least three hours before going to sleep;
- Avoid microwaves
THe Absolute ‘Non-Negotiables’ About Food
- Base your meals on organic, fresh, unprocessed vegetables and proteins — nutrient rich foods;
- Eat only fresh, organic fruits that are in season, but do not have more than 2-3 pieces daily;
- Ensure your foods are fresh and as close to their natural state as possible. Do not eat anything that comes out of cans, boxes, wrappers, packages etc. In other words, avoid most branded products. This will eliminate much of the worry about how healthy pre-packaged things really are, whether they contain harmful additives, and so on…
- Avoid genetically modified foods (GMOs) completely! Most processed foods and an increasing number of non-organic foods have some genetic modifications. The negative and damaging impact of these man-made changes not only affects human health and fertility, but also the environment, due to the destruction of fragile ecosystems, soil pollution and more. Organic and biodynamic produce is best on both counts!
- If you must buy any packaged foods, avoid all preservatives, additives, colourings, flavourings and artificial sweeteners (even in lollies and chewing gum, which you are better off not eating anyway). In essence, any long, unrecognisable names or numbers on food labels. These chemicals are extremely damaging to health and fertility and can also cause foetal abnormalities;
- Cook your vegetables lightly to preserve their nutrients; vitamins are very sensitive to heat. In addition, only use the following cooking methods: —steaming, grilling, roasting, baking, stir-frying (with a little coconut oil only), shredding, eating raw, or casseroling;
- Do not fry or boil your foods, as this damages all nutrients and can dramatically reduce your fertility;
- Avoid heating all vegetable oils as they become damaged, carcinogenic and negative to fertility. Olive, flaxseed and walnut oils have the best fatty acid profiles, but should only be used in salads. When vegetable oils are heated, they are converted into damaging trans fats. Research shows that each 2% increase in the consumption of trans fats decreases fertility by 73%! So think many times before you let any fried foods enter your body (even if only very, very, very occasionally);
- For heating or cooking purposes, coconut oil or ghee is the best fat to use. They both contain a healthy type of saturated fat, which does not become damaged and carcinogenic in cooking. Scientific research demonstrates many health benefits from these fats, including fertility improvement;
- Ensure any meat you prepare for eating is well cooked and NEVER eat raw fish (or raw meat) as the infections they can carry can mean big problems for your fertility;
- All your meat (especially chicken) and eggs MUST be organic. Many of the growth promoters used in rearing ‘non-organic’ animals are oestrogenic. In addition, pesticides and herbicides in their environment and even the water they drink can also be highly oestrogenic. These compounds contribute to major endocrine disruption, leading to hormonal imbalances, including sperm defects, and oestrogen dominance conditions in women, including endometriosis and fibroids. This is potentially a very big problem for your fertility and the development of the reproductive system and sexual organs of your prospective child;
- Eating fish can be a double-edged sword. The essential fatty acids found in fish are very important to fertility but the mercury and other chemical substances such as PCBs (from industry by-products), which potentially enters the body with each mouthful, has a devastating effect on fertility. The solution involves two steps:
- Avoid large fish such as tuna, swordfish, king mackerel, flake, shark and others listed here as well as all crustaceans, oysters and other seafood (due to high levels of pollution): www.oceansalive.org/eat.cfm?subnav=healthalerts;
- Rely on good-quality fish oil supplementation to obtain the amounts of essential fatty acids your body needs (choose a high DHA:EPA ratio, very important for hormonal production and brain development);
- If eating fish you are best to choose small, deep-ocean fish (but definitely not coastal). Some good options include: wild salmon, trout, sardines, herring, John Dory, halibut, monkfish, and red snapper;
- Avoid all other foods to which you suspect you are allergic.
Harvard University published a study in November 2007, with close to 18,000 participants, which showed that a ‘fertility diet + lifestyle’ improved fertility by 69%! So, following these recommendations may well be all you need to make your dream of a healthy baby come true. Be diligent and stick to it as if your life depended on it. Your optimum fertility does!
Excerpted from Eat Your Way To Parenthood: The Diet Secrets of Highly Fertile Couples Revealed (GoKo Publishing 2008) by Gabriela Rosa. Available from www.NaturalFertilityBreakthrough.com.
In 2002, the Center for Disease Control published a survey which identified 7.3 million U.S. women and their partners being affected by infertility. This represents approximately 12% the reproductive-age population in the United States.
Various biological reasons are identified as a possible cause of infertility and include:
• failure to produce and release viable eggs
• failure for the fertilized egg to implant in the uterus
• blocked fallopian tubes
• low sperm count
• vaginal Ph incompatibility
• thyroid pathology
• history of pelvic inflammatory disease
• uterine fibroids
• genetic factors
At the US Federal Source for Women’s Health Information website the following are risks of infertility:
• excess alcohol use
• poor diet
• athletic training
• being overweight or underweight
• sexually transmitted infections
• hormonal imbalances or health problems
Couples experiencing infertility now have numerous medical approaches available to them to address this condition, including in vitro fertilization, hormone therapy for both men and women, as well as surgical and microsurgery procedures. There are also numerous natural or non-clinical lifestyle changes and a whole person health approach for addressing infertility.
A study conducted from 1990-1993 at the University of Surrey, in England, published in the 1993 Journal of Fertility and Sterility, recorded 367 couples with a previous history of infertility, after making changes in their lifestyle, diet and nutrition had an 81 – 83% success rate in conceiving compared to the success rate for assisted conception, which is approximately 20 percent.
The University of Surrey pioneered the study that examines the fundamentals of an individual’s health on conception. Of the study couples, 37% were infertile, 38% had experienced between one and five miscarriages, which did not include other participants with histories of low birth weight, stillbirths and/or birth defects.
After following a program that included improved dietary and nutrition changes, elimination of toxic elements, lifestyle and stress reduction counseling 81% of the previously infertile couples conceived, and 83% of the women who miscarried had a healthy birth within the three years after the trial without miscarrying again.
In addition to the Surrey study, according to Rahul Sachdev, M.D., a specialist in Reproductive Endocrinology and Infertility at the Robert Wood Johnson Medical School in New Brunswick, New Jersey, relieving the stress associated with infertility vastly increases the change of conception. Dr. Sachdev, who recommends yoga therapy states, “Women who are infertile, especially in the long term, are extremely stressed out. One study has shown that the stress levels of an infertile woman are actually similar to those of someone just told they have HIV.” He states that he “has no doubt that stress can lead to infertility. What is controversial,” he goes on to say, “is the question of whether or not stress relief creates fertility.”
Dr. Gary Schwartz, Professor of Psychology and Psychiatry at Yale University, finds that essential oils used in aromatherapy can affect the nervous system to reduce stress and blood pressure. Infertility problems often result in significant emotional stress. Dr Schwartz finds that aromatherapy is a recommended therapy to counter stress and enhance relaxation.
Also, in studies published in the Journal of Fertility and Sterility in 2002, noted Cornell University reproductive endocrinologist Zev Rosenwaks, MD, found a clear link between acupuncture treatments and brain hormones involved in conception. Their research identified that acupuncture increases production of endorphins, a brain chemical that plays a role in regulating the menstrual cycle and enhancing conception.
These are a few of the natural approaches available today to enhance infertility outcomes that may be helpful to the one out of ten US couples experiencing fertility problems and are having difficulty conceiving.
- Dr. Georgianna Donadio
Study Suggests Higher Cancer Rate Among IVF Babies
But researchers found no direct cause-and-effect with assisted reproduction technology
Posted: July 19, 2010
By Serena Gordon
MONDAY, July 19 (HealthDay News) — Children conceived using in vitro fertilization have a higher risk of developing cancer than do children who were conceived naturally, new research shows.
While the study found the risk of cancer was increased by 42 percent for Swedish youngsters conceived with IVF, the absolute risk of cancer was still quite low.
“We found a roughly 50 percent increased risk for cancer in the IVF children, which means that if the risk without IVF is two per 1,000, it increases to three per 1,000 after IVF,” explained study author Dr. Bengt Kallen, a professor emeritus in embryology at the Tornblad Institute at the University of Lund in Sweden.
The findings will be published in the August print issue of Pediatrics, but were posted online on July 19.
In vitro fertilization (IVF) is an assisted reproduction technology. Using eggs harvested from the prospective mother and sperm given by the prospective father, doctors can create human embryos that are then implanted into the mother’s uterus.
Babies born using this technology are known to have an increased risk of birth defects and of birth complications, such as preterm birth. Previous research has also suggested that children born through this method of conception may also have an increased risk of cancer.
Using the Swedish Medical Birth Register, the researchers gathered information on almost 27,000 children who were born using IVF in Sweden from 1982 through 2005.
When they looked at the number of children who had cancer, they found that 53 children born from IVF had developed cancer compared to the expected rate of 38 cases of cancer in non-IVF children.
Other factors appeared to influence the risk of cancer as well. Children born before 37 weeks’ gestation and those with a low birth weight, respiratory problems or a low Apgar score (a test given at birth to assess a newborn’s health), had higher rates of cancer.
A mother’s age, weight, smoking status and the number of miscarriages she’d already had didn’t appear to affect a child’s cancer risk. A multiple birth pregnancy also didn’t appear to affect the risk of cancer.
Cancers of the blood, such as acute lymphoblastic leukemia, were the most common, affecting 18 children. The next most common were cancers of the eye or central nervous system, affecting 17 children.
Although it’s not clear what’s to blame for the increase, the study authors think it’s unlikely that IVF is at the root of the increased risk of cancer.
“This study is interesting and thought-provoking, and it adds to our growing knowledge of potential IVF consequences,” said Dr. David Cohen, chief of reproductive medicine at the University of Chicago.
“But, it’s difficult to think what the biological plausibility would be. If it were something that occurs during the in vitro process or some substance in the media used, I would think that it would cause a much higher number of cancers. This may just be a statistical oddity,” he added.
“This is the largest study that I’m aware of, and it does suggest an increased risk of childhood cancers … but it doesn’t really delineate whether it’s the IVF process or the patient selection. Is this increase due to the procedure, or is it secondary due to a difference in the patient population?” said Dr. Edward Illions, a reproductive endocrinology specialist at the Montefiore Medical Center in New York City and the Montefiore Institute for Reproductive Medicine in Hartsdale, N.Y.
The three experts do not believe these findings will have a significant influence on a couple’s decision to have the IVF procedure.
“The absolute risk is so small that it will hardly influence the decision to get an IVF,” Kallen said.
“This adds more information to the [pre-IVF] counseling session, but I don’t think it will change the decision. The absolute risk is still well less than 1 percent,” said Cohen.
Health Tip from Dr Marilyn Glenville, PhD
Lack of Periods (Amenorrhoea)
Herbs can help your body restore hormone balance and reduce the impact of stress, with the ultimate aim of restoring your periods. Agnus Castus is one of those hergs. High levels of the hormone prolactin and imbalances in levels of follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) can all inhibit ovulation and your menstrual cycle. Agnus castus helps to regulate the action of your pituitary gland, which stimulates the release of all these hormones, to bring your body back to balance. Take 1tsp tincture in a little water, or 200-300mg in capsule form, twice daily. It can take up to 6 months for the herb to take effect in your body, so you will need to be patient. However, keep taking it until your periods are regular again. Then, once you’ve restored a regular cycle, gradually reduce your daily dosage of agnus castus, so that after a couple of months winding down, your menstrual cycle continues without the t! rigger of the herb.
So what is the best way to optimise your fertility?
In my many years in private practice I’ve develop the 11 Pillars of Fertility — the blueprint that has helped numerous patients create the pregnancy and baby of their dreams. The 11 Pillars are the basis of all the essentials that must be in place if you and your partner want to ensure yourselves the best possible chance of having the healthiest baby and/or overcome fertility problems.
Here are three very important pillars that will help your odds of turning your dream into reality:
1. Healthy Diet
This is an absolutely vital aspect of optimum fertility. If your diet is not supporting your body’s metabolic functions your ability to conceive and carry a healthy pregnancy to term will suffer.
2. Environmental and lifestyle
Today through our environment we are in direct contact with over 4 million chemicals — most of which are dangerous for the healthy development of the egg, sperm and embryo. The problem is that often dangerous chemicals, disguised as pretty labels enter our homes and are free to have their destructive effects without us even realising they are damaging our health and fertility.
In addition to this our lifestyle has a huge impact on fertility and reproduction. Things such as smoking, alcohol, coffee, unfiltered drinking and cooking water, recreational substances and more — will all have a devastating effect on female and male fertility.
This is a greatly underestimated key to optimum fertility. The mind-body connection is real and it is taken for granted. If you think you are infertile, you re-enforce a belief that continues to manifest in your life, through your unconscious will. The turning point is realising that right now you can take action to change all aspect you want in your life including your health and reproduction. When it comes to fertility, faith and acceptance of your existing situation with love and understanding frees and enables you to choose to move forward in healthier attempts to create your desire of becoming a proud parent.
Optimizing your ability to conceive a healthy baby, overcoming infertility and carrying a pregnancy to term is very possible. It requires the total commitment of both partners towards a better outcome and several specific changes in how you do certain things — but as the old saying goes: “Do your part and the heavens will come to your aid”.
Exposure to endocrine disruptors associated with early onset of menopause
Knox SS. J Clin Endocrinol Metab. 2011;doi:10.1210/jc.2010-2401.
Higher levels of perfluorocarbons in the body are associated with increased odds of early menopause for women aged 42 to 64 years, according to researchers. Women in this age group with high levels of perfluorocarbons also had significantly lower concentrations of estrogen vs. women who had low levels of the endocrine disruptor.
Perfluorocarbons (PFCs) are man-made chemicals used in a variety of household products, including food containers, clothing, furniture, carpets and paints. The broad use of PFCs has resulted in widespread dissemination in water, air, soil, plant life, animals and humans, even in remote parts of the world. PFCs are known to have multiple adverse health outcomes, including cardiovascular risk and immune system impairment. A probability sample of US adults found measurable concentrations of PFCs in 98% of the participants tested, according to The Endocrine Society.
“The current study is the largest ever to be done in the endocrine-disrupting effects of perfluorocarbons in human women,” Sarah Knox, PhD, of the West Virginia University School of Medicine, said in a press release. “Our data show that after controlling for age, women of perimenopausal and menopausal age in this large population are more likely to have experienced menopause if they have higher serum concentrations of PFCs than their counterparts with lower levels.”
The study included 25,957 women aged 18 to 65 years. All were recruited from the C8 Health Project, which comprised a cohort of more than 69,000 adults and children who were studied because of PFC contamination from drinking water in two US states. Knox and researchers ascertained menopausal status of the women and then measured serum concentrations of PFCs and estradiol.
According to the results, there was an association between PFC exposure, decreased estradiol and early menopause in women aged older than 42 years. The researchers also found an inverse association between PFC levels and estradiol in women of child-bearing age, but this association was not statistically significant.
The causality between PFC exposure and onset of menopause remains unclear, Knox said.
“Part of the explanation could be that women in these age groups have higher PFC levels because they are no longer losing PFCs with menstrual blood anymore, but it is still clinically disturbing because it would imply that increased PFC exposure is the natural result of menopause,” she said in the release.
Greek DHEA Success Study
Premature ovarian failure and dehydroepiandrosterone
Leonidas Mamas M.D., Ph.D. Eudoxia Mamas BSc.
Neogenesis IVF Centre, 3 Kifisias Ave, 151 23 Marousi, Athens, Greece
Leonidas Mamas M.D., Ph.D.
Neogenesis IVF Centre, 3 Kifisias Ave, 151 23 Marousi, Athens, Greece
FAX: +30 210 6836090
Fertility and Sterility Journal (www.fertstert.org)
DHEA proved to be significantly effective in the treatment of POF in the first five cases of an ongoing study. All patients showed an improved gonadotrophin hormonal profile and, more importantly, all achieved pregnancy.
Since the first patient with premature ovarian failure (POF) referred to our Centre was successfully treated with dehydroepiandrosterone (DHEA) giving birth to a healthy baby, all subsequent POF patients followed the same treatment protocol. Receiving very encouraging results (FSH level was decreased in all first five patients and all achieved pregnancy) it was decided to study the DHEA action in depth for a reasonable length of time and a larger number of patients in order to confirm the effectiveness of this particular therapeutic regime.
- Ovarian failure is a natural consequence of the ageing process. Unfortunately, a great number of women experience premature ovarian failure (POF) while still in the reproductive age. POF is a condition characterized by amenorrhoea or oligomenorrhoea due to the early reduction of ovarian follicles (1), along with hypergonadotrophic and hypooestrogenic hormonal changes that affect women before the age of 40. Women suffering from POF present major difficulties with fertility and conception (2).
- More often, POF presents with secondary amenorrhoea (3) and affects 1 to 5% of women (4). A great number of aetiological factors have been associated with POF including genetics, autoimmune disease, iatrogenic and viral. In the majority of POF cases however, a cause cannot be clearly identified and are referred as idiopathic POF (3).
- The causes of POF are vast and therefore treatment options are equally numerous but share one common target; pregnancy. The list of therapies includes clomiphene citrate, gonadotrophins, oestrogens, GnRH analogues, oral contraceptives, corticosteroids, combinations of the above or, if nothing else succeeds, egg donation. With these treatments 6.3 % of all women suffering from POF become pregnant (2).
- Dehydroepiandrosterone (DHEA) is an endogenous steroid that originates from the zona reticularis of the adrenal cortex and the ovarian thecal cells, in women (5). Its production starts with the conversion of cholesterol being an important step in the formation of testosterone first and then to estradiol in peripheral tissues. It is therefore, an important prohormone for ovarian follicular sex steroidogenesis (6).
- The concentrations of DHEA in women remain high during the reproductive years and then, progressively, decrease. Many hypotheses have been made on how DHEA promotes fertility. It is known that DHEA is an important step in the production of testosterone, oestradiol and androstenedione. If, however, the level of DHEA is low, the concentration of these hormones are expected to be also low (5). Furthermore, DHEA is believed to increase follicular insulin-like growth factor – 1, that can promote the gonadotrophin effect (7). Moreover, in rat models, DHEA has been shown to promote a polycystic environment in the ovaries with increased levels of active oocytes and decreased atretic effects. A similar response has been documented in women exposed to androgens (8).
- In our IVF Centre, the first patient, that agreed to follow DHEA treatment was a 37 year old woman, with FSH 102 mIU/mL, referred to us by an endocrinology clinic for egg donation, in April 2006. In the preparation process, oestradiol valerate was given to the patient in order to improve the endometrial thickness. However, the response was very poor, so it was decided to administer DHEA instead, in an attempt to increase the level of endogenous oestrogens. Surprisingly, two months in the DHEA treatment, the patient reported her first period in nine months of amenorrhoea and three months later the level of FSH had dropped to 18,9 mIU/mL (Case 1, Table I). The patient conceived naturally and gave birth to a healthy baby boy.
- Following this successful outcome, it was decided to apply the same protocol to other patients with POF. The treatment consisted of two 25mg micronized dehydroepiandrosterone dietary supplement capsules per day (BIO-DH Natural Organics Laboratories inc. USA). The decision to stop, continue, decrease or increase the DHEA administration was based on various factors; FSH, LH and E2 levels, the presence of period, or conception.
- So far, a further four cases with POF were treated with DHEA. Case 2, was a Greek woman living in Switzerland who was referred in our Centre for egg donation. She suffered of 12 months amenorrhoea with FSH 112 mIU/mL when she visited our centre and agreed to try DHEA as a final step before egg donation. Within one month on DHEA, her FSH had dropped to 30 mIU/mL and two months later, her period reappeared. Natural conception occurred on the third month of treatment, currently being 27 weeks pregnant.
- Case 3, was a troubled patient with POF and a history of two unsuccessful IUIs and one IVF. She responded relatively quickly to DHEA, with her FSH decreased to 12.5 mIU/mL, just two months in therapy, while her LH levels remained high (70 mIU/mL) despite the drop of FSH. Following the reappearance of periods, the patient underwent intrauterine tuboperitoneal insemination (IUTPI) (9). She is now 14 weeks pregnant.
- Case 4, a 38 year old patient, visited our Centre following four failed IVF attempts. She agreed to start DHEA therapy in order to reduce the levels of FSH. Approximately, two months into the treatment she conceived naturally. Unfortunately, at 7 weeks gestation the patient had a missed abortion. The FSH level increased within one month since the patient’s missed abortion. She is currently willing to restart DHEA therapy.
- Case 5 proved to be slightly more complicated. Her starting FSH was 45 mIU/mL. Similarly to all the other cases already treated with DHEA, she began with two 25 mg BIO – DH capsules daily. However, three months into the treatment, her FSH levels had dropped only slightly, even though she reported regular periods. With the patient’s consent it was decided to increase the dose of DHEA to three 25 mg capsules daily. A month later, FSH levels were reduced to 14 mIU/mL and the patient is now 11 weeks pregnant.
- As back as 1998, the best, if only, chance of women with POF to achieve pregnancy was egg donation (10). DHEA proved to be an effective first step treatment of POF. The 50mg daily dose was sufficient in most cases, except one, who received 75mg daily instead, due to poor response to 50mg. DHEA administration was continued for two to 6 months and stopped when pregnancy was ensured, initially by pregnancy test, followed by ultrasound scan.
- Literature offers quite a few studies presenting DHEA administration as a treatment to increase the oocyte quality and quantity. Moreover, DHEA increases the production of endogenous oestrogens. Our first experience of the effectiveness of DHEA for the treatment of POF was a poor responder to oestradiol valerate. Following DHEA therapy, the endometrial thickness was increased and normal periods reappeared along with a reduction of the levels of FSH.
- The same therapeutic regime was successfully used to the second case. The patient shared many similarities to the first one: same hormonal profile, age and was also referred for egg donation. Sharing their experience in a specialised internet IVF forum, DHEA treatment became known to a number of women with the same problem and eventually some of them visited our Centre.
- All patients with POF that agreed to receive DHEA therapy had already undergone full hormonal and thyroid function tests. The longest period of DHEA administration in the above cases was approximately six months. None of the patients wished to stop receiving DHEA and no side effects were reported.
- Within the last year, DHEA was been implemented in our Centre for the treatment of POF. The positive results were an unexpected surprise to us, so much so, that we decided to study the treatment further with a larger number of patients and in a longer period of time. Through this correspondence we wanted to present these promising initial findings of an ongoing study in our IVF Centre.
1. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Williams textbook of endocrinology. 10th ed. Philadelphia: Saunders, 2003: 637 – 638.
2. van Kasteren YM, Schoemaker J. Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy. Hum Reprod Update 1999;5:483 – 492.
3. Meskhi A, Seif MW. Premature ovarian failure. Curr Opin Obstet Gynecol 2006;18:418 – 426.
4. The Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril 2006;86(Suppl 4):148 – 155.
5. Burger HG. Androgen production in women. Fertil Steril 2002; 77(Suppl 4):S3–5.
6. Casson PR, Lindsay MS, Pisarska MD, Carson SA, Buster JE. Dehydroepianrosterone supplementation augments ovarian stimulation in poor responders: a case series. Hum Reprod 2000;15:2129 – 2132.
7. Casson PR, Santoro N, Elkind-Hirsch K, Carson SA, Hornsby PJ, Abraham G, et al. Postmenopausal dehydroepiandrosterone administration increases free insulin-like growth factor-I and decreases high-density lipoprotein: a six-month trial. Fertil Steril 1998;70:107–10.
8. Barad D, Gleicher N. Effect of dehydroepianrosterone on oocyte and embryo yields, embryo grade and cell number in IVF. Hum Reprod 2006;21:2845 – 2849.
9. Mamas L. Comparison of fallopian tube sperm perfusion and intrauterine tuboperitoneal insemination: a prospective study. Fertil Steril 2006;85:735 – 740.
10. Anasti JN. Premature ovarian failure. Fertil Steril 1998;70:1 – 15.