Comparison of Blood Flow in the Arteriae Uterinae in Ovarian Stimulation Cycles for IVF/ICSI, in Hormonal Replacement Cycles and Natural Cycles for Frozen Embryo Transfer
Conditions: Endometrial Receptivity
Sponsor: ART Fertility Clinics LLC

 
      Comparison of blood flow in the arteriae 
uterinae in ovarian stimulation cycles for 
IVF / ICSI, in hormonal replacement cycles 
and Natural cycles for Frozen Embryo 
Transfer 
1901-ABU-002-BL 

 
 
 
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Project Title 
     Comparison of blood flow in the arteriae uterinae in ovarian stimulation cycles for IVF / ICSI, in hormonal 
replacement cycles and Natural cycles for Frozen Embryo Transfer 
 
Project Code:  
1901-ABU-002-BL 
 
Research Area:  
Endometrial receptivity 
 
Date: 
06/02/2019 
 
Keywords: 
Uterine blood flow, arteria uterina, ovarian stimulation, frozen embryo transfer, hormonal replacement 
cycle, natural cycle 
Sponsor information 
Name 
IVIRMA Middle East Fertility Clinic, Abu Dhabi, UAE 
Adress 
Marina Village, Villa B 22, Abu Dhabi, UAE 
e-mail 
Barbara.lawrenz@ivirma.com 
Phone / Fax 
00971 2 6667049 
Principal Investigator information 
Name and surname 
Barbara Lawrenz, M.D., PhD 
Filiation 
IVIRMA Middle East Fertility Clinic, Abu Dhabi, UAE 
e-mail 
Barbara.lawrenz@ivirma.com 
Phone / Fax 
00971 2 6667049 
Responsible for the administrative management of the study 
Name and surname 
Barbara Lawrenz, M.D., PhD 
Filiation 
IVIRMA Middle East Fertility Clinic, Abu Dhabi, UAE 
e-mail 
Barbara.lawrenz@ivirma.com 

 
 
 
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Phone 
00971 2 6667049 

 
 
 
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Research team members 
Professor Human Fatemi   
IVIRMA Abu Dhabi 
human.fatemi@ivirma.com 
Dr Barbara Lawrenz  
IVIRMA Abu Dhabi 
barbara.lawrenz@ivirma.com 
Dr Laura Melado Vidales  
IVIRMA Abu Dhabi  
laura.melado@ivirma.com 
Dr Carol Coughlan 
IVIRMA Dubai 
carol.coughlan@ivirma.com 
Dr. Desislava Markova  
IVIRMA Abu Dhabi  
Desislava.markova@ivirma.com 
 
 

 
 
 
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Responsibilities and Signatures 
By signing this protocol from the project entitled:       
Those undersigning state that:  
- 
This study respects the ethical and legal rules and follows good clinical practice in its implementation 
- 
It has the material and human resources needed to carry out the study, without interfering in other 
studies or clinical tasks usually entrusted to them 
- 
They are committed that each subject is treated and controlled according the approval granted by 
the Ethics Committee for Clinical Research, Institutional Review Board, remaining committees and 
the involved authorities 
- 
Collaborators included in this study are adequately trained for its implementation, they will have an 
active participation, and they consent thereto. 
 
 
 
Center and/or Laboratory Director 
 
 
 
 
 
 
 
 
 
 
 
 
Prof. Dr. Human Fatemi 
IVI RMA Abu Dhabi Director 
 
Date 
 
 
 
 
Principal Investigator 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dr. Barbara Lawrenz 
IVI RMA Abu Dhabi  
 
Date 
 
 
 
 
 

 
 
 
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Table of contents 
Project Title................................................................................................................................................................................................ 1 
Sponsor information .................................................................................................................................................................................. 1 
Principal Investigator information ............................................................................................................................................................. 1 
Responsible for the administrative management of the study ................................................................................................................. 1 
Research team members ........................................................................................................................................................................... 3 
Responsibilities and Signatures ................................................................................................................................................................. 4 
Table of contents ....................................................................................................................................................................................... 5 
Abstract ..................................................................................................................................................................................................... 6 
List of acronyms ......................................................................................................................................................................................... 6 
AIM: main objective/research question .................................................................................................................................................... 7 
Secondary Objectives/research questions ................................................................................................................................................. 7 
Introduction ............................................................................................................................................................................................... 7 
Background: .......................................................................................................................................................................................... 7 
Justification: .......................................................................................................................................................................................... 7 
Methodology ............................................................................................................................................................................................. 7 
A. 
Study Design ................................................................................................................................................................................ 8 
B. 
Study period and context ............................................................................................................................................................ 8 
C. 
Reference Population .................................................................................................................................................................. 8 
D. 
Subject Inclusion/exclusion criteria............................................................................................................................................. 8 
E. 
Intervention and Follow-up ......................................................................................................................................................... 8 
F. 
Collection of biological samples and information ..................................................................................................................... 10 
Statistical metodology ............................................................................................................................................................................. 11 
A. 
Data base .................................................................................................................................................................................. 11 
B. 
Study Variables .......................................................................................................................................................................... 11 
C. 
Sample Size ............................................................................................................................................................................... 12 
D. 
Statistical data analysis ............................................................................................................................................................. 12 
Work plan ................................................................................................................................................................................................ 13 
Ethical issues ............................................................................................................................................................................................ 13 
Funding .................................................................................................................................................................................................... 15 
ANNEX 1. Estimation of the research Project marginal costs ..................................................................... Error! Bookmark not defined. 
Insurance ................................................................................................................................................................................................. 15 
Publication and diffusion ......................................................................................................................................................................... 15 
References ............................................................................................................................................................................................... 15 
 

 
 
 
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Abstract 
To evaluate the influence of ovarian stimulation for IVF / ICSI on the blood flow in the arteriae uterinae as 
well as whether there is an influence of the type of endometrial preparation for frozen embryo transfer (FET) 
with either hormonal replacement therapy or natural cycle on the blood flow of the arteria uterina left / 
right. Blood flow in the arteriae uterinae will be measured by Doppler ultrasound and calculating the 
pulsatility index (PI) and resistance index (RI).   
Until now, it is not clear, whether hormonal stimulation for IVF / ICSI and administration of estradiol tablets 
in the context of preparing the endometrium for embryo transfer will influence the blood flow in the aa. 
uterinae at all. Until now, the optimal means of endometrial preparation for “Frozen Embryo Transfer” cycle 
is not clear and study results are contradictory. It is known, that there are remarkable differences in the 
endocrinological milieu between natural cycles and hormonal replacement cycles. 
This study will measure the blood flow in the aa. uterinae in women, undergoing firstly ovarian stimulation 
for IVF / ICSI and later either HRT or NC for FET. 
 
List of acronyms 
ICSI 
Intracytoplasmic sperm injection 
IVF 
In vitro fertilization 
A. 
aa.  
Arteria 
arteriae 
PI 
Pulsatility Index 
RI 
Resistance Index 
FET 
Frozen Embryo Transfer 
NC 
Natural Cycle 
HRT 
GnRH 
Hormonal Replacement Cycle 
Gonadotropin-Releasing-Hormone 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
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AIM: main objective/research question 
The primary aim of this observational prospective study is to evaluate, whether there is a difference in the 
blood flow, calculated as PI and RI in the arteriae uterinae right / left between women, undergoing HRT- or 
NC-cycle for FET. Measurements on the day of cycle start and the day of progesterone rise in NC-cycles / 
start of progesterone administration in HRT-cycles (+/- 1 - 2 days) will be performed. 
Secondary Objectives/research questions 
- 
To evaluate differences (delta) between the mean PI (between right and left A. uterine) and mean RI 
(between right and left A. uterine) on the day of cycle start and the day of ovulation induction - 1 - 2 
days 
- 
To compare thickness of the lining between HRT or NC. 
- 
To compare number of days of estradiol exposure before the embryo transfer between HRT or NC. 
 
Introduction 
A. Background:  
A wide spectrum of different factors, including uterine receptivity and endometrial thickness (Abdalla et al, 
1994; Noyes et al, 1995) and endometrial texture (Bakos et al, 1993), have been implicated as crucial factors 
in implanation. It has also been suggested that uterine receptivity is related to the uterine blood flow. Due to 
the availability of ultrasound Doppler measurements, the uterine blood flow can be assessed non-invasively 
by transvaginal Doppler ultrasonography.  
It is also known, that there are remarkable differences in the endocrinological milieu between natural cycles, 
ovarian stimulation cycles for IVF / ICSI and hormonal replacement cycles. Those differences may lead to 
different flow pattern in the vessels, providing blood supply to the uterus.  
Until now, there are no data whether there is a difference in the blood flow of the aa. Uterinae .  
 
B. Justification:  
Until now, the changes in the blood flow of the aa. uterinae during hormonal stimulation for IVF / ICSI as 
well as during the preparation for FET are unclear. Additionally, the “best” approach to prepare the 
endometrium and further on to perform a frozen embryo transfer is still not clear and the data are 
contradictive. This study will evaluate whether there is any change in blood flow during hormonal 
stimulation for IVF/ICSI and during different types of endometrial preparation for FET. In case this study 
would show that the blood flow of the arteria uterina right and left is influenced negatively by one of the 
approaches, used for endometrial preparation of the FET, then this should be taken into account in future 
when deciding for one or the other approach.   
 
Methodology 

 
 
 
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A. Study Design 
- 
Prospective cohort study, observational and unicentric (in IVIRMA Middle East Fertility Clinic, Abu 
Dhabi, UAE). 
 
B. Study period and context 
- 
Patients who are treated for primary / secondary infertility in IVIRMA Middle East Fertility Clinic, Abu 
Dhabi, UAE 
- 
Estimated study duration: 6 - 8 month 
- 
Study would start after approval of the study protocol by EC of IVIRMA Middle East Fertility Clinic 
Abu Dhabi. 
- 
Study would end after inclusion of the number of patients, estimated due to the sample size 
calculation 
 
C. Reference Population 
Pat. with primary / secondary infertility, who undergo an ovarian stimulation treatment for IVF/ICSI and 
subsequently are planned for FET with vitrified embryos, either as HRT-FET or as NC-FET  
D. Subject Inclusion/exclusion criteria 
Inclusion criteria: 
- 
Patients who undergo ovarian stimulation in a GnRH-antagonist protocol for IVF / ICSI 
- 
Patients who have vitrified embryo(s) 
- 
Preparation for FET either in HRT or NC cycle 
Exclusion criteria: 
- 
Poor responder according to Bologna criteria (Ferraretti et al.) as follows: 
- 
 At least two of the following three features must be present: 
- (i) Advanced maternal age (≥40 years) or any other risk factor for POR; 
- (ii) A previous POR (≤3 oocytes with a conventional stimulation protocol); 
- (iii) An abnormal ovarian reserve test (i.e. AFC, 5–7 follicles or AMH, 0.5 –1.1 ng/ml). 
- 
Uterine surgery for removal of fibroids (hysteroscopic, laparoscopic) or removal of uterine septum 
- 
Endometriosis 
- 
Asherman-Syndrome 
- 
Previous cytotoxic treatment  
- 
Previous radiation of the uterus / adnexal region 
- 
Known hypertension 
- 
Intake of Aspirin or similar medication which might influence the blood flow 
- 
Status after tubal ligation 
- 
Status after surgery in the adnexal region on 1 side 
E. Intervention and Follow-up 
- 
Patient will present themselves on day 2 / 3 of their period. 

 
 
 
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- 
Patients will undergo ovarian stimulation for IVF / ICSI in a GnRH-antagonist protocol: Start of 
stimulation medication (HMG, recFSH) on either day 2 or 3 of the cycle, dosage according to the 
ovarian response. From day 5 of stimulation a GnRH-antagonist will be added to prevent premature 
ovulation. Medication for ovulation induction (hCG, GnRH-agonist or dual trigger) will be given when 
at least 3 follicles are ≥ 17 mm. 
- 
Patients will be planned for FET in either HRT or NC, according to the physician´s decision.  
- 
 Factors to recommend HRT FET: irregular cycle, PCO, unavailability for treatment monitoring 
- 
 Factors to recommend NC FET: regular cycle 28 -33 days, availability for treatment monitoring 
 
Endometrial preparation approaches: 
 
Artificial (HRT) Cycles:   
- 
Commence E2 4mg from day 2/3 of period for 3 days  
- 
Increase E2 to 6mg on day 4 of E2 treatment. E2 dose may be increased according to clinician 
discretion based on endometrial thickness. 
- 
The patient will be scanned transvaginally throughout the HRT cycle to not only monitor endometrial 
development but to also exclude the presence of a dominant follicle on the ovaries.  
- 
In conjunction with ultrasound monitoring the patient will undergo serial measurements of serum 
LH, estradiol and progesterone levels.  
- 
Commence the initial progesterone dose of 100mg at 22hrs (vaginal suppository) after ≥ 10 days and 
≤ 16 days of estradiol administration when the minimal endometrial thickness achieved is 6mm with 
a trilaminar appearance.  
- 
Subsequently increase progesterone administration to 100mg vaginally three times daily. Continue 
estradiol administration 6mg (3 tablets daily). Embryo transfer is scheduled 5 days following the 
initial initiation of progesterone 
 
Spontaneous natural cycles:   
- 
Commencing on the second day of menses and intermittently throughout the patients’ natural cycle 
ultrasound scans will be performed to monitor follicular growth. 
- 
In conjunction with ultrasound monitoring the patient will u/7ndergo serial measurements of serum 
LH, estradiol and progesterone levels to accurately determine the timing of ovulation. These serum 
hormonal levels will be measured with an automated Elecsys® immunoanalyzer (Roche Diagnostics, 
Mannheim, Germany).  
- 
The LH surge will be considered to have begun when the concentration rises by 180% above the 
most recent serum value and continues to rise thereafter (Irani et al. 2017, Fatemi et al., 2010).  
- 
Day 1 after the LH rise, a decrease in estradiol concentration is identified. Twenty four hours later 
progesterone concentrations rise with a level of greater than or equal to 1.5nmol /L confirming 
ovulation (day 0) (Irani et al., 2017; Speroff et al.). This is considered as day 0 with initiation of 
vaginal progesterone 100mg (vaginal suppository) at 22pm that night. The following day (day 1) the 
patient increases progesterone administration to 100mg vaginally three times daily (8 hourly) and 
continues this regime until 7 weeks gestation as per clinic protocol. Embryo transfer is scheduled 5 
days (day 5) following confirmation of ovulation (day 0). 
For all study arms, transvaginal scan will be performed after the patient had emptied the bladder and is 
positioned in lithotomic position. 
Measurement of the Doppler in the aa. uterinae: 

 
 
 
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A sagittal section of the uterus will be obtained and the cervical canal and internal cervical os will be 
identified. The transducer will be gently tilted from side to side and color flow mapping will be used to 
identify each uterine artery along the side of the cervix and uterus at the level of the internal os. Pulsed 
wave Doppler will be used with the sampling gate set at 2 mm to cover the whole vessel and care will be 
taken to ensure that the angle of insonation is less than 30º. When three similar consecutive waveforms are 
obtained, the PI and peak systolic velocity (PSV) will be measured and the mean PI of the left and right 
arteries calculated.  
Images of the blood flow measurements will be taken and stored in an access-restricted folder. After 
completion of the study recruitment and data analysis, the images will be destroyed. 
Timing for measurement of the Doppler in the aa. Uterinae will be performed: 
- 
Ovarian stimulation cycle: day 2 or 3 of the cycle; day of ovulation induction or 1 to 2 days before in 
case patient will not be seen directly on the day of ovulation induction 
- 
FET cycle: 
- 
HRT: day 2 or 3 of the cycle and day of start of progesterone administration or 1 to 2 days before in 
case patient will not be seen directly on the day when she starts progesterone 
- 
NC: day 2 or 3 of the cycle and day of start of progesterone rise or 1 to 2 days before in case patient 
will not be seen directly on the day when progesterone starts to rise 
 
F. Collection of biological samples and information 
No biological samples will be collected for this study 

 
 
 
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Statistical methodology 
A. Data base 
The database will be rigorously defined with the variables destined to be analyzed according to the 
objectives set. The necessary information will be exported from the clinical information manager, SIVIS, to a 
table in Excel format through a database-based query system. The data which is not recorded in SIVIS will be 
collected in a password-coded EXCEL file to guarantee the data protection. 
The exported data will be duly codified in order to protect the clinical and personal information of the 
patients according to the applicable law in the place where the research project is carried out. 
Finally, and prior to the statistical study, an exploratory data analysis will be carried out to review the quality 
of the information extracted. 
B. Study Variables 
EXPOSURE VARIABLES (INDEPENDENT) 
- 
Type of endometrial stimulation. Categorical dichotomous variable (HRT or natural cycle) 
MAIN-OUTCOME MEASURE (DEPENDENT) 
- 
Difference in the blood flow, calculated as PI and RI, between the HRT- and the NC-FET cycles, on the 
day of progesterone administration / progesterone rise. Quantitative continuous variable 
SECONDARY OUTCOME MEASURES (DEPENDENT) 
- 
δS11 : Continuous quantitative variable measured as the differences between average PI value on the 
day of cycle start and the day of ovulation induction - 1 - 2 days. 
- 
δS12: Continuous quantitative variable measured as the differences between average RI value on the 
day of cycle start and the day of ovulation induction - 1 - 2 days. 
- 
Thickness of the lining. Continuous quantitative variable measured in millimeters (mm). 
- 
Number of days of estradiol exposure before the embryo transfer. Discrete quantitative variable. 
CONTROL VARIABLES 
- 
Cycles days before start of progesterone administration. 
- 
In HRT cycles: amount (mg) of administered Estradiol. 
- 
Age of the patient 
- 
BMI of the patient 
- 
Number of previous pregnancies 
- 
Number of previous C-sections 
- 
Number of previous miscarriages 
- 
Smoker status: Smoking yes/no 
 
 

 
 
 
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C. Sample Size 
So far, no study has been published evaluating the PI and RI of the arteria uterina between HRT- and NC-
FETs.  
The study of Tekay et al. compared the PI of the arteria uterina in a total of 57 patients in fresh ET´s after 
ovarian stimulation and FET with HRT-preparation of the endometrium.  However, this article does not study 
all the variables of our interest. Besides, it has low statistical power and our populations are different, so we 
consider that it is more convenient to carry out a pilot study to study descriptively the variables of interest in 
our population.  
As this will be a pilot study, we plan to include 30 patients in each arm (HRT / NC), therefore we would 
estimate that we will have to include approximately 80 patients in total, as at the time of ovarian stimulation 
it will not be clear which type of FET patient will undergo later on. This approach was chosen in order not to 
interrupt patient recruitment. As this is expected to be a 2 : 1 recruitment (HRT : NC), an intra-group 
homogeneity analysis will be performed and if there are differences, patients from this group will be 
randomly selected for statistical analysis. Besides, in anticipation of potential participants wishing to 
withdraw from the study, an additional 5% of patients to the total sample will be added to cover possible 
losses, recruiting a total of 84 participants. 
D. Statistical data analysis 
EXPLORATORY DATA ANALYSIS 
A statistical summary of the data collected in the study describing patient’s population, cycle’s most relevant 
parameters together with clinical results will be provided.  
- 
Categorical variables will be presented in frequency tables, providing absolute frequencies 
and proportion of each level of each factor in the sample.  
- 
Continuous variables will be summarized according the mean, standard deviation and 95%-
confidence interval, all of them will be represented by diagrams or densities quartiles. 
Exploratory data analysis will allow evaluating data quality and detecting anomalies.  
HOMOGENEITY ANALYSIS 
Although the inclusion criteria and study design tend to preserve the homogeneity of study, it is important 
to ensure comparability between groups for each control variable. Since each patient is assigned to a group 
according to clinical criteria and not by random assignment between groups, it will be important to perform 
a homogeneity analysis to ensure that the effect studied may be due to the type of endometrial preparation 
and not to the effect that may be caused by a control variable behaving differently between the two study 
groups. 
Consequently, categorical variables will be compared using the χ2 test, and for quantitative variables, a t-
Student test will be applied (if we can assume normality, if it is not possible, we will use the Kruskal-Wallis 
test).  
OBJECTIVE ASSESSMENT 
To assess the primary objective, and considering the descriptive nature of any pilot study, confidence 
intervals of 90%, 95% and 99% will be provided for the blood flow level in each group, and for the difference 

 
 
 
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between the comparison groups. A basic comparison test will also be provided on an indicative basis. In 
order to do this, and considering the size of the sample, we will first apply tests of the normality of the data. 
If these tests are favourable, a t-Student test will be applied. In case of not being able to assume normality, 
we will apply a non-parametric test. 
We will proceed in the same way for the rest of the secondary objectives. 
Work plan 
Phase I: drafting of protocol (Barbara Lawrenz, Laura Melado, Desislava Markova) and review / approval 
through UAGI and EC approval 
Phase II: Patient recruitment and follow-up (Barbara Lawrenz, Laura Melado) 
Phase III: Data analysis (Barbara Lawrenz, designated statistician from UAGI) 
Phase IV: Drafting and reviewing of manuscript, submission and publication (Barbara Lawrenz, Laura Melado, 
Desislava Markova, Carol Coughlan, Human Fatemi) 
 
  
2019 
  
Jan Feb 
Mar Apr 
May Jun 
Jul 
Aug 
Sep 
Oct 
Nov 
Dec 
Phase I 
  
  
  
  
  
  
  
  
  
  
  
  
Phase II 
  
  
  
  
  
  
  
  
  
  
  
  
Phase III 
  
  
  
  
  
  
  
  
  
  
  
  
Phase IV 
  
  
  
  
  
  
  
  
  
  
  
  
Phase V 
  
  
  
  
  
  
  
  
  
  
  
  
 
2020 
 
Jan 
Feb 
Mar 
Apr 
May 
Jun 
Jul 
Aug 
Sep 
Oct 
Nov 
Dec 
Phase I 
 
 
 
 
 
 
 
 
 
 
 
 
Phase II 
 
 
 
 
 
 
 
 
 
 
 
 
Phase III 
 
 
 
 
 
 
 
 
 
 
 
 
Phase IV 
 
 
 
 
 
 
 
 
 
 
 
 
Phase V 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ethical issues 
This Research Project respects the fundamental principles of the Declaration of Helsinki, the Council of 
Europe Convention on Human Rights and Biomedicine, the UNESCO Universal Declaration on the Human 
Genome and Human Rights, as well as the requirements of Health Authority Abu Dhabi, UAE, for protection 
of personal data and bioethics. 

 
 
 
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For the inclusion of all patients in the study, it is needed signed informed consent, which is approved by the 
Ethics Committee from the research centres 

 
 
 
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Funding 
No funding needed 
 
Needs funding 
No 
Externally Funded project 
No 
Funding Institution 
Haga 
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aquí 
para 
escribir texto. 
External Funding plan (if 
no funding is available yet) 
No funding needed 
IVIRMA Funding requested 
Choose an item. 
Internally Funded project 
 
Funding time range 
 
 
Budget 
 
 
Insurance 
IVIRMA Abu Dhabi has an Insurance Policy in force that conforms to current legislation and with coverage to 
compensate and indemnify cases of ill health or injury, which may arise in connection with their participation 
in the study, within routine clinical practice. 
However for this observational study, no insurance is needed 
Publication and diffusion 
- 
Ultrasound in Obstetrics and Gynecology, IF 5.6 
- 
Fertility and Sterility, IF 4.8  
- 
ESHRE 
- 
ASRM 
References 
- 
Abdalla, H.I., Brooks, A.A., Johnson, M.R., Kirkland, A., Thomas, A. and Studd, J.W.W. (1994) 
Endometrial thickness: a predictor of implantation in ovum recipients? Hum. Reprod, 9, 363-365. 
- 
Noyes, N., Liu, H.-C., Sultan, K., Schattman, G. and Rosenwaks, Z. (1995) Endometrial thickness 
appears to be a significant factor in embryo implantation in in-vitro fertilization. Hum. Reprod., 10, 
919-922. 

 
 
 
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- 
Bakos, O., Lundkvist, O. and Bergh, T. (1993) Trans vaginal sonographic evaluation of 
endometrial growth and texture in spontaneous ovulatory cycles - a descriptive study. Hum. 
Reprod, 8, 799-806. 
- 
Tekay A, Martikainen H, Jouppila P. Comparison of uterine blood flow characteristics between 
spontaneous and stimulated cycles before embryo transfer. Hum Reprod. 1996 
Feb;11(2):364-8 
- 
Irani M, Robles A, Gunnala V, Reichman D, Rosenwaks Z. Optimal parameters for determining 
the LH surge in natural cycle frozen-thawed embryo transfers. Journal of Ovarian Research 
2017; 10: 70. 
- 
Fatemi H, Kyrou D, Bourgain C, Van den Abbeel E, Griesinger G, Devroey     Cryopreserved                      
thawed human embryo transfer: spontaneous natural cycle is superior to human chorionic 
gonadotropin-induced natural cycle. Fertility & Sterility 2010; 94(6): 2054-2058 
- 
Leon Speroff & Marc A. Fritz. Clinical Gynecologic Endocrinology and Infertility. Part 1. 
Reproductive Physiology. Chapter 6: Regulation of the Menstrual Cycle. Ovulation : 212-216p. 
- 
Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L; ESHRE working 
group on Poor Ovarian Response Definition. ESHRE consensus on the definition of 'poor 
response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 
2011 Jul;26(7):1616-24.