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Semin Reprod Med 2011; 29(4): 353-361
DOI: 10.1055/s-0031-1280920
© Thieme Medical Publishers

From Victim to Survivor to Thriver: Helping Women with Primary Ovarian Insufficiency Integrate Recovery, Self-Management, and Wellness

Evelina Weidman Sterling1 , Lawrence M. Nelson2
  • 1Rachel's Well, Marietta, Georgia
  • 2Integrative Reproductive Medicine Group, Intramural Research Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
Further Information

Publication History

Publication Date:
03 October 2011 (online)

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ABSTRACT

Most women discover that they are infertile in a gradual manner after many failed attempts at conception. By contrast, most women with primary ovarian insufficiency (POI) uncover their infertility as part of an evaluation of other presenting complaints, frequently before attempts at conception have even been contemplated. The most common words women use to describe how they feel in the hours after getting the diagnosis of POI are “devastated,” “shocked,” and “confused.” Clearly, the news propels some patients onto a difficult journey. POI is a serious and incurable chronic disease. The diagnosis is more than infertility and affects a woman's physical and emotional well-being. Management of the condition must address both. Patients face the acute shock of the diagnosis, associated stigma of infertility, grief from the death of dreams, anxiety from the disruption of life plans, confusion around the cause, symptoms of estrogen deficiency, worry over the associated potential medical sequelae such as reduced bone density and cardiovascular risk, and the uncertain future that all of these factors create. There is a need for an evidenced-based integrated program to assist women with POI in navigating the transition to acceptance of the diagnosis, ongoing management of the condition, and ongoing maintenance of wellness in the presence of the disorder. A health-centered approach can gradually replace the disease-centered approach and put patients in partnerships with professional health-care providers. Ideally, the journey transitions each patient from seeing herself as a victim, to a survivor, to a woman who is thriving.

KEYWORDS

Primary ovarian insufficiency (POI) - premature ovarian failure (POF) - integrative care - recovery - self-management

REFERENCES

  • 1 Yongey M, Swanson E, Goleman D. The Joy of Living: Unlocking the Secret and Science of Happiness. New York, NY: Harmony Books; 2007
    Google Scholar
  • 2 Ronald Reagan .Wikipedia. Available at: http://en.wikipedia.org/wiki/Ronald_Reagan Accessed June 29, 2010
    Google Scholar
  • 3 Coulam C B, Adamson S C, Annegers J F. Incidence of premature ovarian failure.  Obstet Gynecol. 1986;  67 (4) 604-606
    PubMedGoogle Scholar
  • 4 Nelson L M. Clinical practice. Primary ovarian insufficiency.  N Engl J Med. 2009;  360 (6) 606-614
    CrossrefPubMedGoogle Scholar
  • 5 Newbould J, Taylor D, Bury M. Lay-led self-management in chronic illness: a review of the evidence.  Chronic Illn. 2006;  2 (4) 249-261
    CrossrefPubMedGoogle Scholar
  • 6 Schmidt P J, Cardoso G M, Ross J L, Haq N, Rubinow D R, Bondy C A. Shyness, social anxiety, and impaired self-esteem in Turner syndrome and premature ovarian failure.  JAMA. 2006;  295 (12) 1374-1376
    CrossrefPubMedGoogle Scholar
  • 7 Orshan S A, Ventura J L, Covington S N, Vanderhoof V H, Troendle J F, Nelson L M. Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women.  Fertil Steril. 2009;  92 (2) 688-693
    CrossrefPubMedGoogle Scholar
  • 8 Davis M, Ventura J L, Wieners M et al.. The psychosocial transition associated with spontaneous 46,XX primary ovarian insufficiency: illness uncertainty, stigma, goal flexibility, and purpose in life as factors in emotional health.  Fertil Steril. 2010;  93 (7) 2321-2329
    CrossrefPubMedGoogle Scholar
  • 9 Groff A A, Covington S N, Halverson L R et al.. Assessing the emotional needs of women with spontaneous premature ovarian failure.  Fertil Steril. 2005;  83 (6) 1734-1741
    CrossrefPubMedGoogle Scholar
  • 10 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed in New York, NY, on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 
    PubMedGoogle Scholar
  • 11 Anthony W A. Recovery from mental illness: the guiding vision of the mental health service in the 1990's.  Psychosoc Rehabil J. 1993;  16 11-23
    PubMedGoogle Scholar
  • 12 Rodgers M L, Norell D M, Roll J M, Dyck D G. An overview of mental health recovery.  Prim Psychiatry. 2007;  14 76-85
    PubMedGoogle Scholar
  • 13 Farber N J, Urban S Y, Collier V U et al.. The good news about giving bad news to patients.  J Gen Intern Med. 2002;  17 (12) 914-922
    CrossrefPubMedGoogle Scholar
  • 14 Bertakis K D, Roter D, Putnam S M. The relationship of physician medical interview style to patient satisfaction.  J Fam Pract. 1991;  32 (2) 175-181
    PubMedGoogle Scholar
  • 15 Fallowfield L. The ideal consultation.  Br J Hosp Med. 1992;  47 (5) 364-367
    PubMedGoogle Scholar
  • 16 Kaplan S H, Greenfield S, Ware Jr J E. Assessing the effects of physician-patient interactions on the outcomes of chronic disease.  Med Care. 1989;  27 (3, Suppl) S110-S127
    CrossrefPubMedGoogle Scholar
  • 17 Fogarty L A, Curbow B A, Wingard J R, McDonnell K, Somerfield M R. Can 40 seconds of compassion reduce patient anxiety?.  J Clin Oncol. 1999;  17 (1) 371-379
    PubMedGoogle Scholar
  • 18 Reich J W, Johnson L M, Zautra A J, Davis M C. Uncertainty of illness relationships with mental health and coping processes in fibromyalgia patients.  J Behav Med. 2006;  29 (4) 307-316
    CrossrefPubMedGoogle Scholar
  • 19 Lemaire G S. More than just menstrual cramps: symptoms and uncertainty among women with endometriosis.  J Obstet Gynecol Neonatal Nurs. 2004;  33 (1) 71-79
    PubMedGoogle Scholar
  • 20 Johnson C L. Regaining self-esteem: strategies and interventions for the infertile woman.  J Obstet Gynecol Neonatal Nurs. 1996;  25 (4) 291-295
    PubMedGoogle Scholar
  • 21 Funnell M M, Anderson R M, Nwankwo R et al.. A study of certified diabetes educators: influences and barriers.  Diabetes Educ. 2006;  32 (3) 359-362 364-366 368-372
    CrossrefPubMedGoogle Scholar
  • 22 Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: Johns Hopkins University Press; 1992
    Google Scholar
  • 23 Rosenblatt P C, Peterson P, Portner J et al.. A cross-cultural study of responses to childlessness.  Cross-Cultural Res. 1973;  8 221-231
    PubMedGoogle Scholar
  • 24 Whiteford L M, Gonzalez L. Stigma: the hidden burden of infertility.  Soc Sci Med. 1995;  40 (1) 27-36
    CrossrefPubMedGoogle Scholar
  • 25 Slade P, O'Neill C, Simpson A J, Lashen H. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic.  Hum Reprod. 2007;  22 (8) 2309-2317
    CrossrefPubMedGoogle Scholar
  • 26 Griffiths K M, Christensen H, Jorm A F, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.  Br J Psychiatry. 2004;  185 342-349
    CrossrefPubMedGoogle Scholar
  • 27 Finkelstein J, Lapshin O. Reducing depression stigma using a web-based program.  Int J Med Inform. 2007;  76 (10) 726-734
    CrossrefPubMedGoogle Scholar
  • 28 Finkelstein J, Lapshin O, Wasserman E. Randomized study of different anti-stigma media.  Patient Educ Couns. 2008;  71 (2) 204-214
    CrossrefPubMedGoogle Scholar
  • 29 Creer T L, Christian W P. Chronically Ill and Handicapped Children, Their Management and Rehabilitation. Champaign, IL: Research Press; 1976
    Google Scholar
  • 30 Lorig K R, Holman H. Self-management education: history, definition, outcomes, and mechanisms.  Ann Behav Med. 2003;  26 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 31 Lorig K. Living a Healthy Life with Chronic Conditions for Ongoing Physical and Mental Health Conditions. Canadian 3rd rev. ed. Boulder, CO: Bull Publishing; 2007
    Google Scholar
  • 32 Parkes C. Bereavement as a psychosocial transition: processes of adaptation to change.  J Soc Issues. 1988;  44 53-65
    CrossrefPubMedGoogle Scholar
  • 33 Greil A L. Infertility and psychological distress: a critical review of the literature.  Soc Sci Med. 1997;  45 (11) 1679-1704
    CrossrefPubMedGoogle Scholar
  • 34 Riley L P, LaMontagne L L, Hepworth J T, Murphy B A. Parental grief responses and personal growth following the death of a child.  Death Stud. 2007;  31 (4) 277-299
    CrossrefPubMedGoogle Scholar
  • 35 Lechner L, Bolman C, van Dalen A. Definite involuntary childlessness: associations between coping, social support and psychological distress.  Hum Reprod. 2007;  22 (1) 288-294
    PubMedGoogle Scholar
  • 36 Orshan S A, Furniss K K, Forst C, Santoro N. The lived experience of premature ovarian failure.  J Obstet Gynecol Neonatal Nurs. 2001;  30 (2) 202-208
    PubMedGoogle Scholar
  • 37 Harvey J H. Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. Champaign, IL: Research Press; 2002
    Google Scholar
  • 38 Clayton P J. Mortality and morbidity in the first year of widowhood.  Arch Gen Psychiatry. 1974;  30 (6) 747-750
    CrossrefPubMedGoogle Scholar
  • 39 Raphael B. The management of pathological grief.  Aust N Z J Psychiatry. 1975;  9 (3) 173-180
    CrossrefPubMedGoogle Scholar
  • 40 Jacobs S, Hansen F, Kasl S, Ostfeld A, Berkman L, Kim K. Anxiety disorders during acute bereavement: risk and risk factors.  J Clin Psychiatry. 1990;  51 (7) 269-274
    PubMedGoogle Scholar
  • 41 Downey G, Silver R C, Wortman C B. Reconsidering the attribution-adjustment relation following a major negative event: coping with the loss of a child.  J Pers Soc Psychol. 1990;  59 (5) 925-940
    PubMedGoogle Scholar
  • 42 Horowitz M J. A model of mourning: change in schemas of self and other.  J Am Psychoanal Assoc. 1990;  38 (2) 297-324
    CrossrefPubMedGoogle Scholar
  • 43 Stroebe M, Stroebe W. Does “grief work” work?.  J Consult Clin Psychol. 1991;  59 (3) 479-482
    PubMedGoogle Scholar
  • 44 Prigerson H G, Frank E, Kasl S V et al.. Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses.  Am J Psychiatry. 1995;  152 (1) 22-30
    CrossrefPubMedGoogle Scholar
  • 45 Menning B E. The emotional needs of infertile couples.  Fertil Steril. 1980;  34 (4) 313-319
    PubMedGoogle Scholar
  • 46 Heckhausen J, Wrosch C, Fleeson W. Developmental regulation before and after a developmental deadline: the sample case of “biological clock” for childbearing.  Psychol Aging. 2001;  16 (3) 400-413
    CrossrefPubMedGoogle Scholar
  • 47 Cheng C. Cognitive and motivational processes underlying coping flexibility: a dual-process model.  J Pers Soc Psychol. 2003;  84 (2) 425-438
    PubMedGoogle Scholar
  • 48 Cheng C, Cheung M W. Cognitive processes underlying coping flexibility: differentiation and integration.  J Pers. 2005;  73 (4) 859-886
    CrossrefPubMedGoogle Scholar
  • 49 Cheng C, Yang F C, Jun S, Hutton J M. Flexible coping psychotherapy for functional dyspeptic patients: a randomized, controlled trial.  Psychosom Med. 2007;  69 (1) 81-88
    CrossrefPubMedGoogle Scholar
  • 50 Tugade M M, Fredrickson B L. Resilient individuals use positive emotions to bounce back from negative emotional experiences.  J Pers Soc Psychol. 2004;  86 (2) 320-333
    PubMedGoogle Scholar
  • 51 Ventura J L, Fitzgerald O R, Koziol D E et al.. Functional well-being is positively correlated with spiritual well-being in women who have spontaneous premature ovarian failure.  Fertil Steril. 2007;  87 (3) 584-590
    CrossrefPubMedGoogle Scholar
  • 52 Bondy C A. Turner Syndrome Study Group . Care of girls and women with Turner syndrome: a guideline of the Turner Syndrome Study Group.  J Clin Endocrinol Metab. 2007;  92 (1) 10-25
    CrossrefPubMedGoogle Scholar
  • 53 Bakalov V K, Vanderhoof V H, Bondy C A, Nelson L M. Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiency in young women with spontaneous premature ovarian failure.  Hum Reprod. 2002;  17 (8) 2096-2100
    CrossrefPubMedGoogle Scholar
  • 54 Hoek A, Schoemaker J, Drexhage H A. Premature ovarian failure and ovarian autoimmunity.  Endocr Rev. 1997;  18 (1) 107-134
    CrossrefPubMedGoogle Scholar
  • 55 Kim T J, Anasti J N, Flack M R, Kimzey L M, Defensor R A, Nelson L M. Routine endocrine screening for patients with karyotypically normal spontaneous premature ovarian failure.  Obstet Gynecol. 1997;  89 (5 Pt 1) 777-779
    CrossrefPubMedGoogle Scholar
  • 56 Smith J A, Vitale S, Reed G F et al.. Dry eye signs and symptoms in women with premature ovarian failure.  Arch Ophthalmol. 2004;  122 (2) 151-156
    CrossrefPubMedGoogle Scholar
  • 57 Wittenberger M D, Hagerman R J, Sherman S L et al.. The FMR1 premutation and reproduction.  Fertil Steril. 2007;  87 (3) 456-465
    CrossrefPubMedGoogle Scholar
  • 58 McConkie-Rosell A, Finucane B, Cronister A, Abrams L, Bennett R L, Pettersen B J. Genetic counseling for fragile x syndrome: updated recommendations of the national society of genetic counselors.  J Genet Couns. 2005;  14 (4) 249-270
    CrossrefPubMedGoogle Scholar
  • 59 Sherman S, Pletcher B A, Driscoll D A. Fragile X syndrome: diagnostic and carrier testing.  Genet Med. 2005;  7 (8) 584-587
    CrossrefPubMedGoogle Scholar
  • 60 American College of Obstetricians and Gynecologists Committee on Genetics . ACOG committee opinion. No. 338: Screening for fragile X syndrome.  Obstet Gynecol. 2006;  107 (6) 1483-1485
    CrossrefPubMedGoogle Scholar
  • 61 Adler R C. Wellness can be achieved through understanding and addressing the elements of metabolic syndrome.  J Altern Complement Med. 2007;  13 (1) 11-12
    CrossrefPubMedGoogle Scholar
  • 62 Chodosh J, Morton S C, Mojica W et al.. Meta-analysis: chronic disease self-management programs for older adults.  Ann Intern Med. 2005;  143 (6) 427-438
    CrossrefPubMedGoogle Scholar
  • 63 Hoeger W WK. Lifetime Physical Fitness and Wellness. 11th ed. Belmont, CA: Wadsworth Cengage Learning; 2010
    Google Scholar
  • 64 Kickbusch I, Payne L. Twenty-first century health promotion: the public health revolution meets the wellness revolution.  Health Promot Int. 2003;  18 (4) 275-278
    CrossrefPubMedGoogle Scholar
  • 65 Ardell D B. The history and future of wellness.  Health Values. 1985;  9 (6) 37-56
    PubMedGoogle Scholar
  • 66 Mackey S. Towards a definition of wellness.  Aust J Holist Nurs. 2000;  7 (2) 34-38
    PubMedGoogle Scholar
  • 67 Gallagher J C. Effect of early menopause on bone mineral density and fractures.  Menopause. 2007;  14 (3 Pt 2) 567-571
    CrossrefPubMedGoogle Scholar
  • 68 Jacobsen B K, Knutsen S F, Fraser G E. Age at natural menopause and total mortality and mortality from ischemic heart disease: the Adventist Health Study.  J Clin Epidemiol. 1999;  52 (4) 303-307
    CrossrefPubMedGoogle Scholar
  • 69 de Kleijn M J, van der Schouw Y T, Verbeek A L, Peeters P H, Banga J D, van der Graaf Y. Endogenous estrogen exposure and cardiovascular mortality risk in postmenopausal women.  Am J Epidemiol. 2002;  155 (4) 339-345
    CrossrefPubMedGoogle Scholar
  • 70 Mondul A M, Rodriguez C, Jacobs E J, Calle E E. Age at natural menopause and cause-specific mortality.  Am J Epidemiol. 2005;  162 (11) 1089-1097
    CrossrefPubMedGoogle Scholar
  • 71 Lisabeth L D, Beiser A S, Brown D L, Murabito J M, Kelly-Hayes M, Wolf P A. Age at natural menopause and risk of ischemic stroke: the Framingham heart study.  Stroke. 2009;  40 (4) 1044-1049
    CrossrefPubMedGoogle Scholar
  • 72 Rossouw J E, Anderson G L, Prentice R L Writing Group for the Women's Health Initiative Investigators et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial.  JAMA. 2002;  288 (3) 321-333
    CrossrefPubMedGoogle Scholar
  • 73 Practice Committee of the American Society for Reproductive Medicine . Current evaluation of amenorrhea.  Fertil Steril. 2004;  82 (Suppl 1) S33-S39
    PubMedGoogle Scholar
  • 74 Pines A, Sturdee D W, Birkhäuser M H, Schneider H P, Gambacciani M, Panay N. Board of the International Menopause Society . IMS updated recommendations on postmenopausal hormone therapy.  Climacteric. 2007;  10 (3) 181-194
    CrossrefPubMedGoogle Scholar
  • 75 Welt C K. Primary ovarian insufficiency: a more accurate term for premature ovarian failure.  Clin Endocrinol (Oxf). 2008;  68 (4) 499-509
    CrossrefPubMedGoogle Scholar
  • 76 Rebar R W. Premature ovarian failure.  Obstet Gynecol. 2009;  113 (6) 1355-1363
    CrossrefPubMedGoogle Scholar
  • 77 Mishell Jr D R, Nakamura R M, Crosignani P G et al.. Serum gonadotropin and steroid patterns during the normal menstrual cycle.  Am J Obstet Gynecol. 1971;  111 (1) 60-65
    PubMedGoogle Scholar
  • 78 Scarabin P Y, Alhenc-Gelas M, Plu-Bureau G, Taisne P, Agher R, Aiach M. Effects of oral and transdermal estrogen/progesterone regimens on blood coagulation and fibrinolysis in postmenopausal women. A randomized controlled trial.  Arterioscler Thromb Vasc Biol. 1997;  17 (11) 3071-3078
    CrossrefPubMedGoogle Scholar
  • 79 Scarabin P Y, Oger E, Plu-Bureau G. EStrogen and THromboEmbolism Risk Study Group . Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk.  Lancet. 2003;  362 (9382) 428-432
    CrossrefPubMedGoogle Scholar
  • 80 Canonico M, Oger E, Plu-Bureau G Estrogen and Thromboembolism Risk (ESTHER) Study Group et al. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study.  Circulation. 2007;  115 (7) 840-845
    CrossrefPubMedGoogle Scholar
  • 81 Gibbons W E, Moyer D L, Lobo R A, Roy S, Mishell Jr D R. Biochemical and histologic effects of sequential estrogen/progestin therapy on the endometrium of postmenopausal women.  Am J Obstet Gynecol. 1986;  154 (2) 456-461
    PubMedGoogle Scholar
  • 82 Bjarnason K, Cerin A, Lindgren R, Weber T. Scandinavian Long Cycle Study Group . Adverse endometrial effects during long cycle hormone replacement therapy.  Maturitas. 1999;  32 (3) 161-170
    CrossrefPubMedGoogle Scholar
  • 83 The Writing Group for the PEPI Trial . Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.  JAMA. 1996;  275 (5) 370-375
    CrossrefPubMedGoogle Scholar
  • 84 Alzubaidi N H, Chapin H L, Vanderhoof V H, Calis K A, Nelson L M. Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure.  Obstet Gynecol. 2002;  99 (5 Pt 1) 720-725
    CrossrefPubMedGoogle Scholar
  • 85 Popat V B, Calis K A, Vanderhoof V H et al.. Bone mineral density in estrogen-deficient young women.  J Clin Endocrinol Metab. 2009;  94 (7) 2277-2283
    CrossrefPubMedGoogle Scholar
  • 86 North American Menopause Society . The role of calcium in peri- and postmenopausal women: 2006 position statement of the North American Menopause Society.  Menopause. 2006;  13 (6) 862-877 quiz 878-880
    CrossrefPubMedGoogle Scholar
  • 87 Holick M F. Vitamin D deficiency.  N Engl J Med. 2007;  357 (3) 266-281
    CrossrefPubMedGoogle Scholar
  • 88 Martyn-St James M, Carroll S. A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes.  Br J Sports Med. 2009;  43 (12) 898-908
    CrossrefPubMedGoogle Scholar
  • 89 Zoll K. What IF? A portrait of infertility. 2010. Available from: http://vimeo.com/11214833 Accessed August 25, 2010
    Google Scholar
  • 90 van Kasteren Y M, Schoemaker J. Premature ovarian failure: a systematic review on therapeutic interventions to restore ovarian function and achieve pregnancy.  Hum Reprod Update. 1999;  5 (5) 483-492
    CrossrefPubMedGoogle Scholar
  • 91 Alper M M, Jolly E E, Garner P R. Pregnancies after premature ovarian failure.  Obstet Gynecol. 1986;  67 (3, Suppl) 59S-62S
    CrossrefPubMedGoogle Scholar
  • 92 Sauer M V, Paulson R J, Lobo R A. Reversing the natural decline in human fertility. An extended clinical trial of oocyte donation to women of advanced reproductive age.  JAMA. 1992;  268 (10) 1275-1279
    CrossrefPubMedGoogle Scholar
  • 93 Abdalla H I, Billett A, Kan A K et al.. Obstetric outcome in 232 ovum donation pregnancies.  Br J Obstet Gynaecol. 1998;  105 (3) 332-337
    PubMedGoogle Scholar
  • 94 Söderström-Anttila V, Tiitinen A, Foudila T, Hovatta O. Obstetric and perinatal outcome after oocyte donation: comparison with in-vitro fertilization pregnancies.  Hum Reprod. 1998;  13 (2) 483-490
    CrossrefPubMedGoogle Scholar
  • 95 Salha O, Sharma V, Dada T et al.. The influence of donated gametes on the incidence of hypertensive disorders of pregnancy.  Hum Reprod. 1999;  14 (9) 2268-2273
    CrossrefPubMedGoogle Scholar
  • 96 Krieg S A, Henne M B, Westphal L M. Obstetric outcomes in donor oocyte pregnancies compared with advanced maternal age in in vitro fertilization pregnancies.  Fertil Steril. 2008;  90 (1) 65-70
    CrossrefPubMedGoogle Scholar
  • 97 Silber S J, Grudzinskas G, Gosden R G. Successful pregnancy after microsurgical transplantation of an intact ovary.  N Engl J Med. 2008;  359 (24) 2617-2618
    CrossrefPubMedGoogle Scholar

Evelina Weidman SterlingPh.D. 

Rachel's Well, 4880 Lower Roswell Rd.

Suite 165, #610, Marietta, GA 30068

Email: evelina@rachelswell.org

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