Baseline dimensions of the human vagina | Human Reproduction | Oxford …

Abstract

BACKGROUND: Vaginal anatomy has been poorly studied. This study aimed to measure baseline dimensions of the undistended vagina of women of reproductive age. METHODS: We combined baseline information collected from five clinical trials using magnetic resonance imaging (MRI) to quantify distribution of a vaginal gel. Seventy-seven MRI scans were performed on 28 women before gel application to establish baseline vaginal measurements. Average dimensions were calculated for each woman and for the population. The influence of potential covariates (age, height, weight and parity) on these dimensions was assessed. RESULTS: MRI measurements are reproducible. The SD surrounding the mean at each anatomical site, and with summary measurements, was significantly smaller with each subject compared with the population. Mean vaginal length from cervix to introitus was 62.7 mm. Vaginal width was largest in the proximal vagina (32.5 mm), decreased as it passed through the pelvic diaphragm (27.8 mm) and smallest at the introitus (26.2 mm). Significant positive associations were parity with vaginal fornix length, age with pelvic flexure width and the height with width at the pelvic flexure. CONCLUSION: No one description characterized the shape of the human vagina. Although there is variation among women, variables such as parity, age and height are positively associated with differences in baseline dimensions.

In comparison with other female pelvic organs, the anatomy of the vagina has been relatively poorly studied. Our knowledge of female pelvic anatomy is based on old descriptions derived from the dissection of a small number of female cadavers. These studies depict the vagina as a straight hollow tube extending vertically upwards towards the sacral promontory (Grant, 1943; Eycleshymer and Schoemaker, 1983; Sultan et al., 1993). In the late 19th century, Hadra in Lesions of the vagina and pelvic floor, discussed the possibility of differences in anatomy for a living patient, also noting that the vaginal axis is different in the upper and lower vagina (defined as the sections of the vagina above and below the pelvic diaphragm) (Hadra, 1888).

New research on pelvic imaging has focused on paediatric, premenopausal and post-menopausal groups; or disease entities like utero-vaginal anomalies, prolapse, fistula or pelvic malignancies. As the focus of past research has been mainly curative, limited study has been conducted on the normal anatomical variations of the vagina of young, healthy and sexually active women (Hafez and Evans, 1978).

The literature, to date, describes the relaxed vagina as a fibro-muscular tube that exists as a collapsed potential space. The shape of the tube is not symmetrical or similar to any known geometric shape. Rather, the vaginal lumen is a potential space with walls that are easily distensible. The overall shape and stretching of the vaginal canal are constrained by the elasticity of the vaginal wall and its relationship to other pelvic organs. The cross section of the relaxed vagina at the level of the cervical os has been classically characterized as an H shape. More recent data suggest that the shape may instead resemble a W (Barnhart et al., 2004a).

Studies have utilized casts to visualize the vagina in three dimensions and to compare vaginal shape, dimensions and surface contact in various ethnic populations. The casts consisted of wax, rapidly solidifying dental impression paste, polyvinyl siloxane, etc. (Morgan, 1961; Richter, 1967; Pendergrass et al., 1996). These studies were limited by the abnormal distension of the vagina; however, they suggested differences among vaginal shapes and dimensions in African-American, Caucasian and Hispanic women (Richter, 1967; Pendergrass et al., 2000). These studies have also suggested a uniform size of all the different shapes of the vagina, and hence have supported the development of the one size fits all vaginal product, formulation or microbicide (Pendergrass et al., 2003).

The goal of this project was to define baseline, nondistended dimensions of the vagina of women of reproductive age using noninvasive imaging. Magnetic resonance imaging (MRI) is the optimal imaging modality for female pelvic organs because the images have excellent spatial resolution and inherently high soft tissue contrast (McCarthy and Vaqueno, 1986; Aronson et al., 1990; Barnhart et al., 2001, 2004b). A secondary goal was to explore the importance of the potential covariates to the dimensions of the human vagina including the impact of age, height, weight, gravity and parity. This information may help researchers optimize vaginal products and drug delivery.

This study was reviewed and approved by the Institutional Review Board of the University of Pennsylvania (Protocol CSA-03-333). This study is an analysis of the baseline MRI at entry in five clinical trials evaluating the distribution of a vaginal product. Data from the following five experimental protocols were utilized for this study:

spread of 3 ml of KY jelly and Replens with and without ambulation (unpublished data);

comparison of two volumes of cellulose sulphate (2.5 ml versus 3.5 ml) with and without ambulation (Barnhart et al., 2005a);

effect of volume (3.0 ml versus 5.0 ml) and ambulation on gel spread, and a substudy on the effect of simulated intercourse on the spread of gel in the vagina (Barnhart et al., 2004b);

study of spread of Savvy gel in the vagina (Barnhart et al., 2005b) and

vaginal distribution of miconazole nitrate suspension from administration of a single vaginal insert (Barnhart et al., 2004c).

As part of these trials, an MRI was performed prior to use of any study product to serve as a baseline for comparison after gel insertion. The trials then quantified the spread of the gel depending on time from application, ambulation of the volunteer, sexual activity of the subject, gel volume and formulation. Other data that quantified the spread of the gel were not included. The analysis for this study is confined to the MRI examinations of these volunteers before using the experimental product to assess the baseline vaginal dimensions of women of reproductive age.

All subjects were aged 1845 years, not at risk for pregnancy (using reliable contraception or abstinence), menstruated regularly and had a normal Papanicolaou smear.

MRI examinations were performed on a dedicated research GE 1.5 Tesla Signa scanner with the assistance of a phased array surface coil centred on the pelvis, to allow small fields of view and to increase signal to noise ratio. We used Sun Ultra workstation, GE Advantage Windows 3.1 software, electronic callipers and digitally stored images to make measurements. The specific details of MR techniques have been published previously (Barnhart et al., 2001, 2004b, 2005a; Pretorius et al., 2002).

The linear length of the vagina was the measurement in the sagittal plane from the external cervical os to the introitus (approximately at the level of the hymeneal ring) (Figure 1). Measurements were also taken at the following anatomic structures in millimetres: (i) two measurements of the posterior vaginal fornixwidth and length in the anterior posterior (AP) and sagittal planes; (ii) transverse measurement of upper vagina (1 cm below the cervix); (iii) pelvic flexure widthtransverse measurement of the flexure of the vagina as it passes through the pelvic diaphragm; (iv) transverse measurement of the lower vagina (3 cm above the introitus); (v) at the level of the introitus (transverse measurement of the vagina 1 cm above the introitus). An example of a measurement in the transverse plane is demonstrated in Figure 2. Measurements at all five demarcated areas were assessed as demonstrated in Figure 2. Surface contact is a summary measurement of the dimensions of the vagina and is calculated by the summation of length of the fornix (AP plane) and the transverse measurement at the four other demarcated sites (Pretorius et al., 2002).

Figure 1.

This figure represents a sagittal image of the human vagina. For illustration purposes this is an image that contains gel mixed with gadolinium contrast (white) to demarcate the vaginal canal. The outline of the vagina can be seen from the cervix and linearly to the introitus. The length of the curved line in the vertical plane is the linear length of the vagina. In this case, the measurement was 63 mm.

Figure 2.

Panel A represents a sagittal image of the human vagina. For illustration purposes these images contain gel mixed with gadolinium contrast (white) to demarcate the vaginal canal. The outline of the vagina can be seen from the cervix (above the dotted line) and linearly in the vertical plane to the introitus. The lateral dimensions of the vagina are measured in the transverse plane as depicted by the dotted line in Panel A. The image is 90 from the vertical plane. Panel B represents complete cross section of the vagina in the transverse plane (1 cm below the cervical os), as the vagina can be seen contiguously from left to right. In this instance, the measurement was 22.5 mm. Surface contact is the sum of the transverse measurements at five demarcated sites in the vagina.

The data were manually checked for any discrepancies resulting from illegal values, extreme outliers and suspicious combinations. We explored various analytical techniques, statistical methods and experimental designs to determine the optimal use of MRI to study the baseline vaginal dimensions. Comparisons using Wilcoxon signed rank tests were made at each distinct measurement within the vagina. SAS (Cary, NC, USA) software was used for statistical analysis.

Multivariate statistical methods were used to summarize the measurements derived from images in the most efficient manner. Repeated analysis of variance and related methods such as mixed effects models were used. Standard data reduction techniques such as principal components and factor analyses were used to form a reduced set of variables. For dichotomous and discrete variables we used appropriate methods such as logistic regression or generalized estimating equation (GEE). All P-values were produced using Fischers exact tests methods. The association of baseline vaginal dimensions with age, race, gravity, parity, height and weight were determined.

Data from 28 volunteers were included in the analysis. The average age of the participants was 29.2 5.8 years with a range of 1839 years. The average height was 1.66 0.05 m with a range of 1.51.7 m. The average weight was 70.13 12.6 kg with a range of 49.995.3 kg. The ethnic distribution of the participants was as follows: 17 were Caucasians, eight African-Americans, two Hispanic and one Asian/Pacific Islander. Of the participants, 14 women were nulliparous and 14 were parous.

Most women (23) participated in one trial; one woman participated in all five. Seventy-seven MRI measurements were performed at baseline (minimum one and maximum twelve per subject). Thirteen of the 28 women had more than one baseline MRI either in the same study or in a second study.

The mean dimensions of the resting human vagina are presented in Table I. These represent the average of the mean values of each of the 28 women. In other words, the average dimensions (and SD) for each woman was calculated if she had more than one MRI. Average dimensions and SD were then calculated for all 28 women. Also presented in Table I are data about the SD of the mean for each woman (within subjects) and the SD of the mean for the population of 28 women (between subjects). The SD within subjects was noted to be significantly less than the SD of the mean for the population of 28 for all individual and summary measurements.

Dimensions of the human vagina with comparison of inter- and intra-person standard deviation

The average linear length of the vagina was 62.7 mm with a relatively large range (40.895 mm). It was noted that the width of the vagina varies throughout its length. The transverse diameter of the vagina is the highest at the level of the vaginal fornices (41.87 mm). The transverse diameter then progressively decreases from the cervical os (32.52 mm) to the pelvic flexure (27.97 mm), mid-lower vagina (27.21 mm), to the narrowest part of the vagina at the level of the vaginal introitus (26.15 mm).

Table II gives results of evaluation of the relationship between baseline vaginal dimensions and covariates of age, weight, height and parity. Surprisingly, there were very few statistically significant associations noted with multivariable analysis. Race was not associated with any differences in measurements of vaginal dimensions. Parity was more predictive than gravidity; hence it was used (and gravidity was eliminated) in the final models. Associations noted were between (i) parity and length of vaginal fornix, (ii) age and vaginal width at the pelvic flexure and (iii) height and vaginal width at the pelvic flexure. A nonstatistically significant trend was noted between the overall length of the vagina and weight (P-value = 0.07).

Factors that affect the baseline dimensions of the human vagina

Neither a single shape nor one summary measurement can characterize the dimensions of the resting vagina in women of reproductive age. Using a noninvasive imaging modality we were able to gain some insight into the anatomy. We confirmed that the axis and dimensions of the upper and lower vagina are different (data not shown). The axis of the lower vagina (from the introitus to the pelvic diaphragm), in relation to a standing woman, is vertical and posterior. The upper vagina changes its axis at the level of the pelvic diaphragm (from the pelvic diaphragm to the cervix), and it becomes more horizontal. We have previously noted that the transverse shape of the upper vagina at the level of the cervix is not always an H and instead is often a W (Barnhart et al., 2004). We also note that measurements of the transverse diameter of the vagina vary along its length. The width of the vagina is narrowest at the level of the introitus with minimal change in width noted at the level of the pelvic diaphragm. Above the pelvic diaphragm, the transverse width of the vagina is greater, around and behind the cervix (the transverse width of the fornix).

The differences in dimensions of the vagina along its length most likely result from the constriction by the surrounding pelvic tissues and the intrinsic compliance of the vaginal walls, resulting in the greater width and compliance of the upper vagina. The differences in the axis and the width of the vagina may not be readily appreciated by the clinician as an inserted speculum straightens the axis of the vagina. Once the speculum is opened, it is sometimes difficult to appreciate the differences in width along the length of the vaginal canal.

There are differences in vaginal dimensions among women. The length of the vagina (from external cervical os to introitus) ranged from approximately 4.19.5 cm, a greater than 100% difference from the shortest to the longest length. There was also a large range in the width of the vagina at all demarcated sites measured. The width and the range of the width tended to increase from the introitus to the fornix. The largest range in the width of the vagina was noted in the width of the posterior fornix, which in the undistended vagina is the portion of the vagina behind (posterior) to the barrel of the cervix. The cervix extends from the upper wall of the vagina into the canal with the external os pointing in the general direction of the introitus. The area of the vagina cephalad to the external os, thus posterior to the barrel of the cervix, is the fornix. Using MRI we were able to measure the posterior fornix in both the transverse plane (right to left) and in the longitudinal plane (in the sagittal plane). Thus, the true length of the vagina is the length from the external os to the introitus plus the longitudinal length of the posterior fornix. These two aspects in length, however, are not in the same linear plane, and the connection between these two lengths will also often include some change in linear direction.

Interestingly, while there were differences in vaginal dimensions among women, there were only small differences in the dimensions when the same woman was imaged multiple times. Over the course of these trials, some women had repeated measurements as much as six months apart, and there was very little variation in these measurements, suggesting that the anatomy does not change substantially over short periods, and measurements using MRI have low intra-person variability.

Notably, few statistically significant associations could be drawn between the potentially influencing factors and baseline dimensions of the vagina. Although it has been suggested that there are racial differences in vaginal dimensions, our data did not demonstrate any such clear-cut differences. We noted that age of a woman is associated with an increase in the transverse diameter at the pelvic flexure. This is consistent with the clinical finding of increasing laxity of the vaginal walls in women of advanced age. Interestingly, by contrast, height of the subject was negatively associated with width of the vagina at the level of the flexion. Weight of a woman tended to be positively associated with overall length of the vagina and presented as a nonstatistically significant trend (P-value 0.050.10). Given the number of statistical comparisons performed in this study, it is possible that some of these findings may be due to chance.

Surprisingly, parity had little association with the overall surface contact and length of the vagina. Parity is associated with a significant increase in the length of the vaginal fornix. The potential effect of parity may be via stretching and elongation of the birth canal at the time of vaginal childbirth. This effect is especially significant in the upper part of the vagina where the dilation, thinning (effacement) and taking up of the cervix is an active process, as opposed to the lower vagina where passive stretching takes place during parturition.

Our summary measurement of surface contact is not a true measure of surface area. It was devised to objectively compare the spread of a vagina gel under experimental protocol to assess the effect of a variable such as time since insertion or gel volume. It is notable that our summary measurements of 137.58 18.37 mm with a range of 103.9165 mm appear to be larger than estimates of surface area reported in other studies. Prior studies that used casts to measure vaginal dimensions reported a surface area of 87.46 mm2, SD 7.8 mm2 and range 65.73107.07 mm2. A direct comparison of these measurements cannot be performed due to differences in methodology and because the casts showed either extrusion of cast material by a small vagina or improper filling in a roomy vagina, leading to understated measurements (Pendergrass et al., 2003). Our measurements of the width of the vagina are similar to those reported, which range from 23.9 to 64.5 mm (Pendergrass et al., 1996, 2003). However, we are unable to characterize the shape of the vagina as a heart, slug, pumpkin seed or parallel sides as suggested by other studies (Pendergrass et al., 1996, 2000, 2003).

The dimensions and shape of the vagina are of great importance in medicine and surgery; however, there appears to be no single way to characterize the size and shape of the human vagina. Although differences exist between women, there are few covariates associated with these differences. There does not appear to be large variation in the dimensions of the vagina within the same woman. Given the large range in the dimensions noted, it is most likely that one size for a vaginal device will not fit all women (Mauck et al., 2004). Prior research has shown that using a single size for fitting two cervical caps leads to the correct fit in only 33% of women. Moreover, it is possible that one volume of a gel intended to cover the vaginal epithelium may not be appropriate for all women. This information can be used to better design various devices used in the vagina. We have previously proved that deployment of a potential microbicide gel in the upper and lower vagina is affected by factors such as ambulation, time since insertion, volume and product (Barnhart et al., 2005). Baseline vaginal dimension may also be an important factor.

Support for this subproject [CSA-03-333] was provided by the Global Microbicide Project [GMP], a program of CONRAD, Eastern Virginia Medical School. The views expressed by the authors do not necessarily reflect the views of CONRAD or GMP.

, Lee RA and Berquist TH (

1990

Obstet Gynecol

846

, Stolpen A, Pretorius ES and Malamud D (

2001

Human Reprod

1151

, Pretorius ES and Malamud D (

2004

Fertil Steril

1383

, Pretorius ES, Marunich R and Hummel A (

2004

J Reprod Med

, Pretorius ES, Timbers K, Shera D, Shabbout M and Malamud D (

2004

Contraception

498

, Pretorius ES, Shaunik A, Timbers KK, Nasution M and Mauck C (

2005

Contraception

, Pretorius ES, Timbers K, Shera D, Shabbout M and Malamud D (

2005

Contraception

357

, Pretorius ES, Shera DM, Shabbout M and Shaunik A (2006) A optimal analysis of the distribution of a microbicide. Contraception 73, 8287

and Schoemaker DM (

1983

A Cross Section in Anatomy

(

1943

An Atlas of Anatomy

123

, Nicholls RJ, Kamm MA, Hudson CN, Beynon J and Bartram CI (

1993

Br J Surg

508

(

1888

and Evans TN (

1978

The Human Vagina

, Lai JJ, Schwartz J and Weiner DH (

2004

Contraception

263

and Vaqueno E (

The rest is here:
Baseline dimensions of the human vagina | Human Reproduction | Oxford ...

World Health Organization reference values for human semen characteristics [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
Economic consequences of overweight and obesity in infertility: a framework for evaluating the costs and outcomes of fertility care [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
Maternal metabolism and obesity: modifiable determinants of pregnancy outcome [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
Brain imaging studies of appetite in the context of obesity and the menstrual cycle [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
The impact of body mass index on semen parameters and reproductive hormones in human males: a systematic review with meta-analysis [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
Options for fertility preservation in prepubertal boys [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
Xenografting of testicular tissue from an infant human donor results in accelerated testicular maturation [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Karyotype of miscarriages in relation to maternal weight [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Endoglandular trophoblast, an alternative route of trophoblast invasion? Analysis with novel confrontation co-culture models [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Regulation of extravillous trophoblast invasion by uterine natural killer cells is dependent on gestational age [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Functional regulation of thymic stromal lymphopoietin on proliferation and invasion of trophoblasts in human first-trimester pregnancy [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Home self-administration of vaginal misoprostol for medical abortion at 50-63 days compared with gestation of below 50 days [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Prospective study of the forearm bone mineral density of long-term users of the levonorgestrel-releasing intrauterine system [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Functional attenuation of human sperm by novel, non-surfactant spermicides: precise targeting of membrane physiology without affecting structure [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Cumulative ongoing pregnancy rate achieved with oocyte vitrification and cleavage stage transfer without embryo selection in a standard infertility program [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Pregnancy outcome in female childhood cancer survivors [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Offering excess oocyte aspiration and vitrification to patients undergoing stimulated artificial insemination cycles can reduce the multiple pregnancy risk and accumulate oocytes for later use [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Avoidance of weekend oocyte retrievals during GnRH antagonist treatment by simple advancement or delay of hCG administration does not adversely affect IVF live birth outcomes [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Who should pay for assisted reproductive techniques? Answers from patients, professionals and the general public in Germany [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Sperm donor limits that control for the 'relative' risk associated with the use of open-identity donors [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Long-term cryostorage of sperm in a human sperm bank does not damage progressive motility concentration [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Screening for biomarkers of spermatogonia within the human testis: a whole genome approach [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
Avoiding transgenerational risks of mitochondrial DNA disorders: a morally acceptable reason for sex selection? [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Cross border reproductive care in six European countries [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Morphometric dimensions of the human sperm head depend on the staining method used [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
ESX1 gene expression as a robust marker of residual spermatogenesis in azoospermic men [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Innovative virtual reality measurements for embryonic growth and development [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Consecutive or non-consecutive recurrent miscarriage: is there any difference in carrier status? [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
A longitudinal study of contraception and pregnancies in the same women followed for a quarter of a century [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Predictors of bleeding and user satisfaction during consecutive use of the levonorgestrel-releasing intrauterine system [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Direct proportional relationship between endometrioma size and ovarian parenchyma inadvertently removed during cystectomy, and its implication on the management of enlarged endometriomas [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Large prospective, pregnancy and infant follow-up trial assures the health of 1000 fetuses conceived after treatment with the GnRH antagonist ganirelix during controlled ovarian stimulation [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Altered aquaporin expression in women with polycystic ovary syndrome: hyperandrogenism in follicular fluid inhibits aquaporin-9 in granulosa cells through the phosphatidylinositol 3-kinase pathway [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Fast-release orodispersible tramadol as analgesia in hysterosalpingography with a metal cannula or a balloon catheter [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Xenotransplantation of cryopreserved human ovarian tissue into murine back muscle [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Predictors of psychological distress in patients starting IVF treatment: infertility-specific versus general psychological characteristics [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Psychological adjustment, knowledge and unmet information needs in women undergoing PGD [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Mothers of IVF and spontaneously conceived twins: a comparison of prenatal maternal expectations, coping resources and maternal stress [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Psychological well-being and sexarche in women with polycystic ovary syndrome [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Is human fecundity declining in Western countries? [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Current achievements and future research directions in ovarian tissue culture, in vitro follicle development and transplantation: implications for fertility preservation [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Human studies on genetics of the age at natural menopause: a systematic review [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Beyond oxygen: complex regulation and activity of hypoxia inducible factors in pregnancy [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Current knowledge of the aetiology of human tubal ectopic pregnancy [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Economic contraction and birth outcomes: an integrative review [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Teratogenic mechanisms of medical drugs [Last Updated On: August 17th, 2024] [Originally Added On: June 5th, 2010]
Levels of semenogelin in human spermatozoa decrease during capacitation: involvement of reactive oxygen species and zinc [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Apoptosis and meiotic segregation in ejaculated sperm from Robertsonian translocation carrier patients [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
In humans, zona pellucida glycoprotein-1 binds to spermatozoa and induces acrosomal exocytosis [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Variants of the EPPIN gene affect the risk of idiopathic male infertility in the Han-Chinese population [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Epidermal clitoral inclusion cysts: not a rare complication of female genital mutilation [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
PCOSMIC: a multi-centre randomized trial in women with PolyCystic Ovary Syndrome evaluating Metformin for Infertility with Clomiphene [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Soluble HLA-G is an independent factor for the prediction of pregnancy outcome after ART: a German multi-centre study [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Obstetric outcomes after transfer of vitrified blastocysts [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Occasional involvement of the ovary in Ewing sarcoma [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Y chromosome microdeletions, sperm DNA fragmentation and sperm oxidative stress as causes of recurrent spontaneous abortion of unknown etiology [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Development and preliminary validation of the fertility status awareness tool: FertiSTAT [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Xenotransplantation of human ovarian tissue to nude mice: comparison between four grafting sites [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Involvement of CFTR in oviductal HCO3- secretion and its effect on soluble adenylate cyclase-dependent early embryo development [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Effect of endometriosis on the protein expression pattern of follicular fluid from patients submitted to controlled ovarian hyperstimulation for in vitro fertilization [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Activin A regulates trophoblast cell adhesive properties: implications for implantation failure in women with endometriosis-associated infertility [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Clinical significance of sperm DNA damage in assisted reproduction outcome [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Fall in implantation rates following ICSI with sperm with high DNA fragmentation [Last Updated On: August 17th, 2024] [Originally Added On: June 17th, 2010]
Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Ultra-conservative fertility-sparing strategy for bilateral borderline ovarian tumours: an 11-year follow-up [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Fertility after autologous ovine uterine-tubal-ovarian transplantation by vascular anastomosis to the external iliac vessels [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Uterus transplantation in the baboon: methodology and long-term function after auto-transplantation [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Prestimulation parameters predicting live birth in anovulatory WHO Group II patients undergoing ovulation induction with gonadotrophins [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Transfer of a selected single blastocyst optimizes the chance of a healthy term baby: a retrospective population based study in Australia 2004-2007 [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Disclosure patterns of mode of conception among mothers and fathers-5-year follow-up of the Copenhagen Multi-centre Psychosocial Infertility (COMPI) cohort [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
A decade of sperm washing: clinical correlates of successful insemination outcome [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Sperm DNA integrity in cancer patients before and after cytotoxic treatment [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
Speriolin is a novel human and mouse sperm centrosome protein [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
No influence of body mass index on first trimester fetal growth [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]
HLA sharing among couples appears unrelated to idiopathic recurrent fetal loss in Saudi Arabia [Last Updated On: August 17th, 2024] [Originally Added On: July 21st, 2010]