Determinants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine

Determinants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine Hasan Arafat, Diaeddin Qamhia, Husam Maqboul, Abdulsalam Al-Khayyat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2799972/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Objective: Infertility is a public health issue with a huge impact on the well-being of affected couples. Despite the traditional valuing of fertility within the Palestinian society, no studies were conducted to detect the determinants of pregnancy outcome in Palestine. This paper aims at detecting the characteristics and pregnancy outcome after assisted reproductive technology (ART) of a sample of the Palestinian society. Materials & Methods: A retrospective observational study was carried out at Razan Medical Center for Infertility. Subjects were assigned 2 categories based on the type of infertility, 7 different categories according to the cause of infertility, and 3 categories for the modality of treatment. Age at marriage, age at presentation, duration of infertility, in addition to regularity of menstruation were also studied. Biochemical pregnancy was considered the endpoint for the purpose of analysis. Results: We reviewed the files of 459 subjects diagnosed with infertility. Of the studied subjects, 79.74% had primary infertility, while 20.26% had secondary. According to diagnosis, 28.85% were found to be infertile due to anovulation, 2.86% due to endometriosis, 16.74% attributed to male factor, 3.3% had tubal damage, while 34.80% had no explainable cause. 13.43% of cases were multifactorial. Four biochemical markers were assessed in our study, thyroid-stimulating hormone (TSH) ( x̄ =2.32±2.46), leutinizing hormone (LH) ( x̄ =6.71±4.90), follicle-stimulating hormone (FSH) ( x̄ =6.59±6.11), and human prolactin (hPRL) ( x̄ =41.88±6.50). The menstrual cycle was regular in 70.58% of subjects, in contrast to 29.41% with irregular cycles. Female mean age at presentation 22.76±5.58, while their mean age of marriage was 22.76±4. Mean duration of infertility was 3.97±6.87. Patients were treated via 3 modalities, ovarian stimulation (2.2%), intrauterine insemination (IUI) (29.58%), and intracytoplasmic sperm injection (ICSI) (68.21%), with a rate of success of 51.85%. Of the studied factors, only diagnosis, FSH, and modality of treatment had a significant impact on the outcome, with p- values of 0.040, 0.003, and <.0.001, respectively. Conclusions: there is a strong relationship between diagnosis prior to intervention, level of FSH and treatment modality on successful outcome of ART. ICSI was found to be superior to other modalities of treatment. We recommend starting with ICSI to save patient time & effort. Obstetrics & Gynecology Infertility assisted reproductive technology follicle stimulating hormone Background Infertility is defined as failure to achieve clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse according to the World Health Organization (WHO) [ 1 ]. For many couples, the lack of ability to have children will have a huge impact on social, physical and sexual activities in their lives [ 2 ]. Infertility is a public health issue for couples in the reproductive age, affecting about 72.4 million women aged 20-44 with an estimation of prevalence of 9% [ 3 ]. Infertility can be classified into primary and secondary; primary infertility refers to couples who have never achieved pregnancy, whereas secondary infertility refers to couples who have conceived at least once before, but now are unable to [ 4 ]. As a result of the huge impact of infertility on individual and social well-being, many epidemiological studies reviewed and analyzed the factors that have been attributed to infertility to provide guidance for the prevention of infertility. Conventionally, these parameters include the age at which to start a family, body mass index, duration of infertility, obstetric history, psychological stress, menstrual regularity, environmental factors, and occupational exposures [ 5 ]. All of the steps must occur correctly during ovulation, fertilization, and implantation in order to achieve pregnancy. Several factors can cause disturbance at any step, whether due to female or male reasons. Female reasons leading to infertility included: hormonal disorders [ 6 ], polycystic ovarian syndrome [ 7 ], premature ovarian failure [ 8 ], endometriosis [ 9 ], fallopian tube obstruction [ 10 ], congenital uterine anomalies [ 11 ], or due to complication of medical diseases (diabetes and hypothyroidism) [ 12 , 13 ]. Male infertility is usually due to sperm abnormalities or hormonal imbalance [ 2 , 14 ]. Middle Eastern cultures, in which the Palestinian culture is part of, put a great emphasis on having larger families, preferably early in their life. [ 15 ]. Palestinian women fertility rate is considered one of the highest in the world, with an average of 4.38 births per woman [ 16 ]. Unfortunately, no studies were conducted to detect the determinants of pregnancy outcome in Palestinian women. This paper aims at detecting the characteristics and pregnancy outcome after assisted reproductive technology (ART) at Razan Medical Center for Infertility. Methods Study design and settings This is a retrospective cohort study. Data was collected from the electronic records of the patients who presented to Razan Center for management and evaluation of infertility between 2015-2018. The study included patients from Razan branches in three major cities in the West Bank of the Palestinian Territories: Nablus, Ramallah and Bethlehem, which serve the whole Palestinian population in the West Bank. Inclusion and exclusion criteria All cases that met WHO definition of infertility, defined as the inability to conceive despite regular, unprotected sexual intercourse for 12 consecutive months were included. Cases that presented for follow-up of normal pregnancy, gender selection, frozen embryo transfer as well as records with missing data were excluded. In addition, cases that did not meet the WHO definition of infertility in terms of duration and inability to have regular sexual intercourse were also excluded. Sample and data collection A total of 459 files were reviewed according to the above-mentioned inclusion & exclusion criteria. Patients were assigned into the following 6 different categories, based on their cause of infertility: male factor, anovulation (including those with polycystic ovarian syndrome (PCOS), ovarian insufficiency, whether premature or age rated, and hypogonadotropic hypogonadism), endometriosis, assigned a separate category due to the ambiguity of the exact mechanism by which it causes infertility, tubal damage, multifactorial, patients with more than one cause of infertility in which a single cause of infertility couldn’t be identified. The unexplained category was reserved for patients with no apparent cause of infertility despite having a regular menstrual cycle; male seminal analysis was found to be normal; normal sexual activity (at least twice a week); and uterine cavity and tubes were found to be normal on hysterosalpingogram. Biochemical markers of infertility included follicle stimulating hormone (FSH), leutenizing hormone (LH), thyroid stimulating hormone (TSH) and human prolactin (hPRL). Other sociodemographic factors were extracted including age at presentation & duration of marriage. Gravidity and parity were recorded using the gravida/para/abortus system (GPA). Patient menstrual status was recorded as regular or irregular based on the patient own answer. At Razan Center for Infertility, three modalities were used for treatment: ovarian stimulation, intrauterine insemination (IUI), and intracytoplasmic sperm injection (ICSI). Data Analysis The primary endpoint of the study was biochemical pregnancy, defined as a positive serum β-human gonadotropin (β-hCG) test. The predictors investigated for association with a positive biochemical pregnancy were diagnosis, level of TSH, day two LH, day two FSH, hPRL, age at marriage, age at presentation, duration of infertility, regularity of the menstrual cycle, and modality of treatment. Endpoint and predictors were described as means and standard deviations (SD) for quantitative variables and as absolute values and percentages for categorical variables. Differences in predictor variables according to the presence or absence of biochemical pregnancy were described using chi-squared test and t -test, as appropriate. Statistical significance was defined as a two-sided p -value <0.05. All data were analyzed using the STATA Data Analysis and Statistical Software, version 14. Results The total number of infertile females who met the inclusion criteria was 459. The mean age of the sample was 26.81 (SD ± 5.84, range 17 to 45 years). The duration of infertility was less than 5 years in 390 females (80.2%), and was 5 years or more in 96 females (19.75%). Three hundred and sixty-six (79.7%) females had primary infertility with the rest of the sample (20.2%) having secondary infertility. Details of the demographic data of the females are listed in Table 1. Table 1. Sample Characteristics (N=459) Mean Age ± SD in years 26.81 ± 5.84 Mean Duration of infertility ± SD in years 3.97 ± 6.87 Primary infertility, N (%) 366 (79.7) Secondary infertility, N (%) 93(20.2) 131 cases (28.85%) were diagnosed as infertile due to anovulation, disregarding whether anovulating was due to PCOS, hypogonadotropic hypogonadism, or premature ovarian failure.76 cases (16.74%) were attributed to male factors, 15 cases (3.3%) were due to tubal damage, 13 cases (2.86%) were due to endometriosis, 158 cases (34.8%) were due to an unexplained cause, defined as patients with no apparent cause of infertility despite having a regular menstrual cycle, and 61 cases (13.43%) being multifactorial (infertility attributed to more than one of the above mentioned causes). 366 (79.74%) were attributed to primary infertility, defined as the inability to conceive despite 12 months of regular, unprotected vaginal intercourse, 324 (70.58%) had regular menses. Ten cases (2.2%) were treated with ovarian stimulation with hormonal treatment constituted. 134 (29.58%) of cases were treated with IUI made, while the majority of the cases (68.21%) were treated with ICSI. Table 2 shows the categorical variables and outcome with p -values. Table 3 lists the mean and SD for biochemical markers of infertility, age at marriage and at presentation and duration of infertility for the total sample, pregnancy and no pregnancy outcomes Table2. Type of infertility, diagnose, menstrual status and modality of treatment for the total sample, pregnancy and non-pregnancy outcomes with p -values (N=459) Total N (%) Pregnant N (%) Non-pregnant N (%) p -value Type of Infertility Primary 366 (79.74) 189 (51.64) 177 (48.36) 0.268 Secondary 93 (20.26) 54 (58.06) 39 (41.94) Diagnosis Anovulation 131 (28.85) 65 (49.62) 66 (50.38) 0.040 Endometriosis 13 (2.86) 10 (76.92) 3 (22.08) Male Factor 76 (16.74) 46 (60.53) 30 (39.47) Tubal Damage 15 (3.30) 11 (73.33) 4 (26.67) Unexplained 158 (34.80) 73 (46.20) 85 (53.80) Multifactorial 61 (13.43) 36 (59.02) 25 (40.98) Menstrual Status Regular 324 (70.58) 168 (51.85) 156 (48.15) 0.469 Irregular 135 (29.41) 75 (55.56) 60 (44.44) Modality of Treatment Ovarian Stimulation 10 (2.20) 4 (40.00) 6 (60.00) <0.001 IUI 134 (29.58) 33 (24.63) 101 (75.37) ICSI 309 (68.21) 201 (65.05) 108 (34.95) Table 3. Mean and SD for biochemical markers of infertility, age at marriage and at presentation and duration of infertility for the total sample, pregnancy and no pregnancy outcomes Total Sample Mean ( ±SD) Pregnant Mean ( ±SD) Non-Pregnant Mean ( ±SD) p -value TSH 0.592 2.32 ± 2.46 2.25 ± 2.38 2.38 ± 2.54 LH 0.995 6.71 ± 4.90 6.71 ± 4.91 6.71 ± 4.89 FSH 0.003 6.59 ± 6.11 6.06 ± 5.72 7.12 ± 6.50 hPRL 36.94 ± 5.78 46.82 ± 7.21 0.282 41.88 ± 6.50 Age at Marriage 0.308 22.76 ±5.58 22.49 ± 4.82 23.03 ± 6.34 Age at Presentation 0.805 26.81 ± 5.84 26.75 ± 5.30 26.88 ± 5.30 Duration of Infertility 0.99 3.97 ± 6.87 3.97 ± 0.29 3.98 ± 0.60 Discussion In our study, we aimed at evaluating the effect of hormones, demographic determinants as well as treatment modality on biochemical pregnancy among a female sample from Palestine. Despite being a developing country, Palestine pattern of fertility is considered distinct compared to that of other, surrounding developing nations in that the high fertility rate coexists with a high level of educations and low level of infant mortality. Moreover, due to the special political situation in Palestine, fertility is not considered a mere biological reality, but a political one; Palestinian women desire to have more children as a means of resisting the continuous displacement and human loss due to ongoing conflict [ 16 ]. In our study, we found a statistically significant relationship ( p -value of 0.003) between pre- in vitro fertilization (IVF) FSH level and biochemical pregnancy, which was in agreement with several studies in which FSH level was found to be a significant negative predictive factor of clinical pregnancy [ 17 , 18 ]. LH level was not statistically insignificant ( p -value of 0.995) with regard to biochemical pregnancy test. This finding was opposed to some studies showing the mean serum concentration of LH was significantly low in couples who conceive in comparison to couples who did not [ 19 , 20 ]. The other studied hormones, namely TSH, and hPRL ( p = 0.592, 0.282, respectively), did not have a statistically significant relationship with the outcome and the success of the pregnancy trial, which was in agreement with previous studies that showed no significant difference between the two groups in the serum concentration of TSH and hPRL [ 19 ]. In addition, we found a very strong relationship between the modality of treatment and biochemical pregnancy. As we predicted, the pre-treatment diagnosis had a statistically significant relationship ( p = 0.04) with the outcome, but in the clinical practice, it is rare for child-bearing age women to have an isolated reproductive disorder, as most of them suffer from multiple conditions [ 21 ], this means that multiple, coexisting reproductive disorders should be taken into account when studying pregnancy outcome, our finding coincides with another study that summarizes all reproductive disorders that could affect the pregnancy outcome in women-childbearing age [ 22 ]. Our results revealed that whether the patient hadn’t had a previous pregnancy (primary infertility), or failed to conceive after one or more successful pregnancies (secondary infertility) had no statistical significance on the outcome ( p = 0.268). Whether the patient had a regular menstrual cycle or not did not impact the outcome of treatment ( p = 0.469). Chronological parameters of the patient did not impact the outcome of treatment as well, the mean age at marriage was relatively the same when comparing that of women with successful outcome compared to those with a failure result (23.03 years of age vs. 22.49 years), the relationship, as expected, was not statistically significant ( p = 0.308). The age of presentation did not have any significant effect on outcome ( p = 0.805), as expected by the close means of the age of successful vs unsuccessful cases (26.75 vs. 26.88). The duration of infertility, measured as the number of years between getting married and presenting to the infertility center. Those who presented before fulfilling one year of infertility were told to come back after fulfilling the required duration, as there were no difference between successful and unsuccessful cases regarding the duration of infertility (both groups had a mean of 3.98), the relationship was statistically insignificant ( p =0.99). These findings might be attributed to the fact that most of the women studied belonged to the same categorical age, and further studies, including more women of a wider spectrum of age categories, should be conducted. Regarding the modality of treatment, a very strong relationship was found between the type of modality and the success of the cycle, as the rate of success for intracytoplasmic sperm injection (ICSI) was significantly higher compared to intrauterine injection and ovarian stimulation (68.21% vs 29.58% vs 2.20%), with p -value of 0.001. This clinical audit is considered the first of its type at Razan Medical Center for infertility, as it will help modify and enhance the clinical practice and patient care. In addition, the large sample size helped define the actual relationships between different determinants. Being a retrospective cohort study, its results are considered relatively strong and reliable. Our study was limited by the high number of incomplete files, manifested by the fact that of the total of 459 infertile females enrolled in the study, only 291 completed their investigations, giving a rate of (63.5%). The insufficient data were in the biochemical markers of infertility included follicle stimulating hormone, and leutenizing hormone. In addition to patient non-adherence and lack of follow-up for some patients, preventing us from knowing the outcome of the treatment. Conclusion & Recommendations In conclusion, we found a strong relationship between FSH and diagnosis with the success of treatment. Our most important finding was the extremely significant relationship between ICSI and positive outcome, as it was superior to both IUI and ovarian stimulation when it comes to achieving a positive end-result. We recommend starting with ICSI with patients adequate for this modality of treatment to save patient time and effort in achieving their desired results. However, this remained an obstacle given how expensive ICSI is compared to IUI. Furthermore, we recommend testing FSH hormone as routine for patient who present to IVF center. Abbreviations Abbreviation Stands for WHO World Health Organization ART Assisted reproductive technology PCOS Polycystic ovary syndrome FSH Follicle-stimulating hormone LH Leutinizing hormone TSH Thyroid-stimulating hormone hPRL Human prolactin GPA Gravida/porta/abortus IUI Intrauterine insemination ICSI Intracytoplasmic sperm injection hCG Human chorionic gonadotropin SD Standard deviation IVF In vitro fertilization Declarations Ethical approval: this manuscript was reviewed and accepted by An-Najah National University International Review Board (IRB) committee Consent for publication: not applicable Availability of data and material: Data essential for the conclusion are included in this manuscript. Additional data can be obtained from the corresponding author on a reasonable request. Competing interests: the authors declare that they have no competing interests. Funding: the authors received no financial support for the research, authorship, and publication of this article. Authors’ contribution: HA, DQ, and HM conceived the study. AK performed analysis. HA, DQ, and HM wrote the original draft of the manuscript. HA and AK revised the manuscript. HA wrote the final manuscript. All authors contributed to the writing and reviewed and approved the manuscript. Acknowledgement: We would like to acknowledge Dr. Salem Abu-Khaizaran, founder and manager of Razan Medical Center for Infertility who helped during the data collection period and provided us with the necessary access. References 1. Zegers-Hochschild F, Adamson GD, de Mouzon J, et al.: International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. 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Kazerooni T, Dehghan-Kooshkghazi M: Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2003, 17:51-56. 7. Lash MM, Yaghamee A, Strohsnitter W, Lalwani S: Association between secondary infertility and fallopian tube obstruction on hysterosalpingography. The Journal of reproductive medicine. 2008, 53:677-680. 8. Shen S-Y, Huang S-Y, Hsieh C-H, Hsu M-I, Cheng C-Y, Hsu C-S: Clinical and biochemical characteristics of women with menstrual disturbance. Taiwanese Journal of Obstetrics and Gynecology. 2014, 53:178-182. https://doi.org/10.1016/j.tjog.2014.04.009 9. Wang PH, Su WH, Sheu BC, Liu WM: Adenomyosis and its variance: adenomyoma and female fertility. Taiwanese journal of obstetrics & gynecology. 2009, 48:232-238. 10.1016/s1028-4559(09)60295-3 10. Lavy G, Diamond MP, DeCherney AH: Ectopic pregnancy: its relationship to tubal reconstructive surgery. Fertility and sterility. 1987, 47:543-556. 10.1016/s0015-0282(16)59100-6 11. Barbanti S, Chiamulera N, Botelho B: Vaginal septoplasty in septate uterus with double cervix. Case Rep Obstet Gynecol. 2014, 2014:367360-367360. 10.1155/2014/367360 12. Codner E, Merino PM, Tena-Sempere M: Female reproduction and type 1 diabetes: from mechanisms to clinical findings. Human reproduction update. 2012, 18:568-585. 10.1093/humupd/dms024 13. Päkkilä F, Männistö T, Hartikainen A-L, Suvanto E: Maternal Thyroid Function During Pregnancy and the Child's Linguistic and Sensory Development in the Northern Finland Birth Cohort 1986. Front Endocrinol (Lausanne). 2018, 9:127-127. 10.3389/fendo.2018.00127 14. Ugwuja EI, Ugwu NC, Ejikeme BN: Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria. African journal of reproductive health. 2008, 12:67-73. 15. Klaus D, Suckow J, Nauck B: The Value of Children in Palestine and Turkey: Differences and the Consequences for Fertility. Current Sociology. 2007, 55:527-544. 10.1177/0011392107077637 16. Pell S: Reproductive decisions in the lives of West Bank Palestinian women: Dimensions and contradictions. Global Public Health. 2017, 12:135-155. 10.1080/17441692.2016.1151541 17. Frazier LM, Grainger DA, Schieve LA, Toner JP: Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment. Fertility and sterility. 2004, 82:834-840. 10.1016/j.fertnstert.2004.02.144 18. Chen YP, Wu WH, Wu HM, Chen CK, Wang HS, Huang HY: Effects of anti-Mullerian hormone and follicle stimulating hormone levels on in vitro fertilization pregnancy rate. Taiwanese journal of obstetrics & gynecology. 2014, 53:313-316. 10.1016/j.tjog.2013.06.012 19. Ashrafi M, Jahanian Sadatmahalleh S, Akhoond MR, Ghaffari F, Zolfaghari Z: ICSI Outcome in Infertile Couples with Different Causes of Infertility: A Cross-Sectional Study. International journal of fertility & sterility. 2013, 7:88-95. 20. Shanmugham D, Vidhyalakshmi RK, M. SH: The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome. 2017. 2017, 7:5. 10.18203/2320-1770.ijrcog20175869 21. Holoch KJ, Savaris RF, Forstein DA, et al.: Coexistence of Polycystic Ovary Syndrome and Endometriosis in Women with Infertility. Journal of Endometriosis and Pelvic Pain Disorders. 2014, 6:79-83. 10.5301/je.5000181 22. Vannuccini S, Clifton VL, Fraser IS, et al.: Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Human reproduction update. 2016, 22:104-115. 10.1093/humupd/dmv044 Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2799972","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":190893156,"identity":"99664cc5-b264-43ac-8ba3-d195ce08c7fb","order_by":0,"name":"Hasan Arafat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYBACAziL+QADQwKPDZDF2HiAOC1sCYwND2TSQFoaiNfS+MDmMJiNV4s5+/GHnwsY7PL525ifP0jIOW+3tv0w0JYam2hcWix7coylZzAkW844xmbYkHDmdvK2M4lALcfSchtwOexADoM0DwOzAcP9BsOGxJ7byWYHgFoYGw7j1nL++ePfPAz1BvLH2D82JP47l2x2/iEBLTcSzIC2HDYwOMYDdBjPATuzG4RsufHGzJrH4LiB4TGewhkJPMkJZjeAtiTg88v59Me3eSqqDeSOsW/4+IPHzt7sfPrDBx9qbHBqgWpEMBPBKhPwKkcD9qQoHgWjYBSMgpEBACa8Y7NMdMEwAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6484-5606","institution":"Augusta Victoria Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Arafat","suffix":""},{"id":190893157,"identity":"ffcd3e46-3f74-4338-b53f-076682e017d9","order_by":1,"name":"Diaeddin Qamhia","email":"","orcid":"","institution":"Specialty Arab Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Diaeddin","middleName":"","lastName":"Qamhia","suffix":""},{"id":190893158,"identity":"265c4566-723c-486f-9a3d-7091762c77ad","order_by":2,"name":"Husam Maqboul","email":"","orcid":"","institution":"Al-Watani Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Husam","middleName":"","lastName":"Maqboul","suffix":""},{"id":190893159,"identity":"2c226f8b-f83e-4a3f-b637-c1e44e78b84c","order_by":3,"name":"Abdulsalam Al-Khayyat","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdulsalam","middleName":"","lastName":"Al-Khayyat","suffix":""}],"badges":[],"createdAt":"2023-04-10 18:12:37","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-2799972/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-2799972/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":35617027,"identity":"5f77df8e-0ef8-426e-9a62-835b366e2fa5","added_by":"auto","created_at":"2023-04-12 02:43:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":239340,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2799972/v2/dc5e35d2-e6ef-46e6-bbfc-cc2928593bb5.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eDeterminants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eInfertility is defined as failure to achieve clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse according to the World Health Organization (WHO)\u0026nbsp;[\u003ca href=\"#_ENREF_1\" title=\"Zegers-Hochschild, 2009 #1\"\u003e1\u003c/a\u003e]. For many couples, the lack of ability to have children will have a huge impact on social, physical and sexual activities in their lives\u0026nbsp;[\u003ca href=\"#_ENREF_2\" title=\"Smith, 2009 #2\"\u003e2\u003c/a\u003e]. Infertility is a public health issue for couples in the reproductive age, affecting about 72.4 million women aged 20-44 with an estimation of prevalence of 9%\u0026nbsp;[\u003ca href=\"#_ENREF_3\" title=\"Boivin, 2007 #3\"\u003e3\u003c/a\u003e]. Infertility can be classified into primary and secondary; primary infertility refers to couples who have never achieved pregnancy, whereas secondary infertility refers to couples who have conceived at least once before, but now are unable to\u0026nbsp;[\u003ca href=\"#_ENREF_4\" title=\"Tabong, 2013 #4\"\u003e4\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a result of the huge impact of infertility on individual and social well-being, many epidemiological studies reviewed and analyzed the factors that have been attributed to infertility to provide guidance for the prevention of infertility. Conventionally, these parameters include the age at which to start a family, body mass index, duration of infertility, obstetric history, psychological stress, menstrual regularity, environmental factors, and occupational exposures\u0026nbsp;[\u003ca href=\"#_ENREF_5\" title=\"Sharma, 2013 #5\"\u003e5\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eAll of the steps must occur correctly during ovulation, fertilization, and implantation in order to achieve pregnancy. Several factors can cause disturbance at any step, whether due to female or male reasons. Female reasons leading to infertility included: hormonal disorders\u0026nbsp;[\u003ca href=\"#_ENREF_6\" title=\"Kazerooni, 2003 #6\"\u003e6\u003c/a\u003e], polycystic ovarian syndrome\u0026nbsp;[\u003ca href=\"#_ENREF_7\" title=\"Lash, 2008 #7\"\u003e7\u003c/a\u003e], premature ovarian failure\u0026nbsp;[\u003ca href=\"#_ENREF_8\" title=\"Shen, 2014 #8\"\u003e8\u003c/a\u003e], endometriosis\u0026nbsp;[\u003ca href=\"#_ENREF_9\" title=\"Wang, 2009 #9\"\u003e9\u003c/a\u003e], fallopian tube obstruction\u0026nbsp;[\u003ca href=\"#_ENREF_10\" title=\"Lavy, 1987 #10\"\u003e10\u003c/a\u003e], congenital uterine anomalies\u0026nbsp;[\u003ca href=\"#_ENREF_11\" title=\"Barbanti, 2014 #11\"\u003e11\u003c/a\u003e], or due to complication of medical diseases (diabetes and hypothyroidism)\u0026nbsp;[\u003ca href=\"#_ENREF_12\" title=\"Codner, 2012 #12\"\u003e12\u003c/a\u003e,\u003ca href=\"#_ENREF_13\" title=\"Päkkilä, 2018 #13\"\u003e13\u003c/a\u003e]. Male infertility is usually due to sperm abnormalities or hormonal imbalance\u0026nbsp;[\u003ca href=\"#_ENREF_2\" title=\"Smith, 2009 #2\"\u003e2\u003c/a\u003e,\u003ca href=\"#_ENREF_14\" title=\"Ugwuja, 2008 #14\"\u003e14\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMiddle Eastern cultures, in which the Palestinian culture is part of, put a great emphasis on having larger families, preferably early in their life.\u0026nbsp;[\u003ca href=\"#_ENREF_15\" title=\"Klaus, 2007 #16\"\u003e15\u003c/a\u003e]. Palestinian women fertility rate is considered one of the highest in the world, with an average of 4.38 births per woman\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Pell, 2017 #17\"\u003e16\u003c/a\u003e]. Unfortunately, no studies were conducted to detect the determinants of pregnancy outcome in Palestinian women. This paper aims at detecting the characteristics and pregnancy outcome after assisted reproductive technology (ART) at Razan Medical Center for Infertility.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design and settings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective cohort study. Data was collected from the electronic records of the patients who presented to Razan Center for management and evaluation of infertility between 2015-2018. The study included patients from Razan branches in three major cities in the West Bank of the Palestinian Territories: Nablus, Ramallah and Bethlehem, which serve the whole Palestinian population in the West Bank.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion and exclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll cases that met WHO definition of infertility, defined as the inability to conceive despite regular, unprotected sexual intercourse for 12 consecutive months were included. Cases that presented for follow-up of normal pregnancy, gender selection, frozen embryo transfer as well as records with missing data were excluded. In addition, cases that did not meet the WHO definition of infertility in terms of duration and inability to have regular sexual intercourse were also excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample and data collection\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 459 files were reviewed according to the above-mentioned inclusion \u0026amp; exclusion criteria. Patients were assigned into the following 6 different categories, based on their cause of infertility: male factor, anovulation (including those with polycystic ovarian syndrome (PCOS), ovarian insufficiency, whether premature or age rated, and hypogonadotropic hypogonadism), endometriosis, assigned a separate category due to the ambiguity of the exact mechanism by which it causes infertility, tubal damage, multifactorial, patients with more than one cause of infertility in which a single cause of infertility couldn\u0026rsquo;t be identified. The unexplained category was reserved for patients with no apparent cause of infertility despite having a regular menstrual cycle; male seminal analysis was found to be normal; normal sexual activity (at least twice a week); and uterine cavity and tubes were found to be normal on hysterosalpingogram.\u003c/p\u003e\n\u003cp\u003eBiochemical markers of infertility included follicle stimulating hormone (FSH), leutenizing hormone (LH), thyroid stimulating hormone (TSH) and human prolactin (hPRL). Other sociodemographic factors were extracted including age at presentation \u0026amp; duration of marriage. Gravidity and parity were recorded using the gravida/para/abortus system (GPA). Patient menstrual status was recorded as regular or irregular based on the patient own answer. At Razan Center for Infertility, three modalities were used for treatment: ovarian stimulation, intrauterine insemination (IUI), and intracytoplasmic sperm injection (ICSI).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary endpoint of the study was biochemical pregnancy, defined as a positive serum \u0026beta;-human gonadotropin (\u0026beta;-hCG) test. The predictors investigated for association with a positive biochemical pregnancy were diagnosis, level of TSH, day two LH, day two FSH, hPRL, age at marriage, age at presentation, duration of infertility, regularity of the menstrual cycle, and modality of treatment. Endpoint and predictors were described as means and standard deviations (SD) for quantitative variables and as absolute values and percentages for categorical variables. Differences in predictor variables according to the presence or absence of biochemical pregnancy were described using chi-squared test and \u003cem\u003et\u003c/em\u003e-test, as appropriate. Statistical significance was defined as a two-sided \u003cem\u003ep\u003c/em\u003e-value \u0026lt;0.05. All data were analyzed using the STATA Data Analysis and Statistical Software, version 14.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe total number of infertile females who met the inclusion criteria was 459. The mean age of the sample was 26.81 (SD \u0026plusmn; 5.84, range 17 to 45 years). The duration of infertility was less than 5 years in 390 females (80.2%), and was 5 years or more in 96 females (19.75%). Three hundred and sixty-six (79.7%) females had primary infertility with the rest of the sample (20.2%) having secondary infertility. Details of the demographic data of the females are listed in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:275.1pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:19.3pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 1. Sample Characteristics (N=459)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:202.3pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:202.3pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMean Age \u0026plusmn; SD in years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e26.81 \u0026plusmn; 5.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:202.3pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMean Duration of infertility \u0026plusmn; SD in years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.97 \u0026plusmn; 6.87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:202.3pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ePrimary infertility, N (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e366 (79.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:202.3pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSecondary infertility, N (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e93(20.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e131 cases (28.85%) were diagnosed as infertile due to anovulation, disregarding whether anovulating was due to PCOS, hypogonadotropic hypogonadism, or premature ovarian failure.76 cases (16.74%) were attributed to male factors, 15 cases (3.3%) were due to tubal damage, 13 cases (2.86%) were due to endometriosis, 158 cases (34.8%) were due to an unexplained cause, defined as patients with no apparent cause of infertility despite having a regular menstrual cycle, and 61 cases (13.43%) being multifactorial (infertility attributed to more than one of the above mentioned causes).\u003c/p\u003e\n\u003cp\u003e366 (79.74%) were attributed to primary infertility, defined as the inability to conceive despite 12 months of regular, unprotected vaginal intercourse, 324 (70.58%) had regular menses. Ten cases (2.2%) were treated with ovarian stimulation with hormonal treatment constituted. 134 (29.58%) of cases were treated with IUI made, while the majority of the cases (68.21%) were treated with ICSI. Table 2 shows the categorical variables and outcome with \u003cem\u003ep\u003c/em\u003e-values. Table 3 lists the mean and SD for biochemical markers of infertility, age at marriage and at presentation and duration of infertility for the total sample, pregnancy and no pregnancy outcomes\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width:467.5pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable2. Type of infertility, diagnose, menstrual status and modality of treatment for the total sample, pregnancy and non-pregnancy outcomes with \u003cem\u003ep\u003c/em\u003e-values (N=459)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:85.6pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTotal\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ePregnant\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eNon-pregnant\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57.1pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:85.6pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eType of Infertility\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ePrimary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e366 (79.74)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e189 (51.64)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e177 (48.36)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:57.1pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.268\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSecondary\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e93 (20.26)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e54 (58.06)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e39 (41.94)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width:85.6pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eDiagnosis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAnovulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e131 (28.85)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e65 (49.62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e66 (50.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width:57.1pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.040\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e13 (2.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10 (76.92)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3 (22.08)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMale Factor\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e76 (16.74)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e46 (60.53)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e30 (39.47)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTubal Damage\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e15 (3.30)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e11 (73.33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4 (26.67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eUnexplained\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e158 (34.80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e73 (46.20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e85 (53.80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMultifactorial\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e61 (13.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e36 (59.02)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e25 (40.98)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:85.6pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMenstrual Status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eRegular\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e324 (70.58)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e168 (51.85)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e156 (48.15)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:57.1pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.469\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eIrregular\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e135 (29.41)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e75 (55.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e60 (44.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width:85.6pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eModality of Treatment\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eOvarian Stimulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10 (2.20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4 (40.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6 (60.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:57.1pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eIUI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e134 (29.58)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e33 (24.63)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e101 (75.37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87.9pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eICSI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.35pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e309 (68.21)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e201 (65.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e108 (34.95)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width:386.05pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 3. Mean and SD for biochemical markers of infertility, age at marriage and at presentation and duration of infertility for the total sample, pregnancy and no pregnancy outcomes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTotal Sample\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMean (\u003c/span\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026plusmn;SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ePregnant\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMean (\u003c/span\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026plusmn;SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eNon-Pregnant\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMean (\u003c/span\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026plusmn;SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.95pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTSH\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.592\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.32 \u0026plusmn; \u003cspan dir=\"RTL\"\u003e2.46\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.25 \u0026plusmn; 2.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.38 \u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e 2.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eLH\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.995\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6.71 \u0026plusmn; 4.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6.71 \u0026plusmn; 4.91\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6.71 \u0026plusmn; 4.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eFSH\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.003\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6.59 \u0026plusmn; 6.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6.06 \u0026plusmn; 5.72\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e7.12 \u0026plusmn; 6.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding: 0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ehPRL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e36.94 \u0026plusmn; 5.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:81.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e46.82 \u0026plusmn; 7.21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.282\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e41.88 \u0026plusmn; 6.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAge at Marriage\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.308\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e22.76 \u0026plusmn;5.58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e22.49 \u0026plusmn; 4.82\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e23.03 \u0026plusmn; 6.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eAge at Presentation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.805\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:83.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e26.81 \u0026plusmn; 5.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e26.75 \u0026plusmn; 5.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e26.88 \u0026plusmn; 5.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:83.9pt;border:solid windowtext 1.0pt;border-top:none;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eDuration of Infertility\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83.55pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74.15pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81.5pt;border-color: currentcolor windowtext windowtext currentcolor;border-style: none solid solid none;border-width: medium 1pt 1pt medium;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:62.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:1.0pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:83.55pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.97 \u0026plusmn; 6.87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.15pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.97 \u0026plusmn; 0.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.5pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.98 \u0026plusmn; 0.60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we aimed at evaluating the effect of hormones, demographic determinants as well as treatment modality on biochemical pregnancy among a female sample from Palestine. Despite being a developing country, Palestine pattern of fertility is considered distinct compared to that of other, surrounding developing nations in that the high fertility rate coexists with a high level of educations and low level of infant mortality. Moreover, due to the special political situation in Palestine, fertility is not considered a mere biological reality, but a political one; Palestinian women desire to have more children as a means of resisting the continuous displacement and human loss due to ongoing conflict\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Pell, 2017 #17\"\u003e16\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, we found a statistically significant relationship (\u003cem\u003ep\u003c/em\u003e-value of 0.003) between pre-\u003cem\u003ein vitro\u0026nbsp;\u003c/em\u003efertilization (IVF) FSH level and biochemical pregnancy, which was in agreement with several studies in which FSH level was found to be a significant negative predictive factor of clinical pregnancy\u0026nbsp;[\u003ca href=\"#_ENREF_17\" title=\"Frazier, 2004 #18\"\u003e17\u003c/a\u003e,\u003ca href=\"#_ENREF_18\" title=\"Chen, 2014 #19\"\u003e18\u003c/a\u003e]. LH level was not statistically insignificant (\u003cem\u003ep\u003c/em\u003e-value of 0.995) with regard to biochemical pregnancy test. This finding was opposed to some studies showing the mean serum concentration of LH was significantly low in couples who conceive in comparison to couples who did not\u0026nbsp;[\u003ca href=\"#_ENREF_19\" title=\"Ashrafi, 2013 #20\"\u003e19\u003c/a\u003e,\u003ca href=\"#_ENREF_20\" title=\"Shanmugham, 2017 #21\"\u003e20\u003c/a\u003e]. The other studied hormones, namely TSH, and hPRL (\u003cem\u003ep\u003c/em\u003e = 0.592, 0.282, respectively), did not have a statistically significant relationship with the outcome and the success of the pregnancy trial, which was in agreement with previous studies that showed no significant difference between the two groups in the serum concentration of TSH and hPRL\u0026nbsp;[\u003ca href=\"#_ENREF_19\" title=\"Ashrafi, 2013 #20\"\u003e19\u003c/a\u003e]. In addition, we found a very strong relationship between the modality of treatment and biochemical pregnancy. As we predicted, the pre-treatment diagnosis had a statistically significant relationship (\u003cem\u003ep\u003c/em\u003e = 0.04) with the outcome, but in the clinical practice, it is rare for child-bearing age women to have an isolated reproductive disorder, as most of them suffer from multiple conditions\u0026nbsp;[\u003ca href=\"#_ENREF_21\" title=\"Holoch, 2014 #22\"\u003e21\u003c/a\u003e], this means that multiple, coexisting reproductive disorders should be taken into account when studying pregnancy outcome, our finding coincides with another study that summarizes all reproductive disorders that could affect the pregnancy outcome in women-childbearing age\u0026nbsp;[\u003ca href=\"#_ENREF_22\" title=\"Vannuccini, 2016 #23\"\u003e22\u003c/a\u003e]. Our results revealed that whether the patient hadn\u0026rsquo;t had a previous pregnancy (primary infertility), or failed to conceive after one or more successful pregnancies (secondary infertility) had no statistical significance on the outcome (\u003cem\u003ep\u003c/em\u003e = 0.268). Whether the patient had a regular menstrual cycle or not did not impact the outcome of treatment (\u003cem\u003ep\u003c/em\u003e = 0.469). Chronological parameters of the patient did not impact the outcome of treatment as well, the mean age at marriage was relatively the same when comparing that of women with successful outcome compared to those with a failure result (23.03 years of age vs. 22.49 years), the relationship, as expected, was not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.308). The age of presentation did not have any significant effect on outcome (\u003cem\u003ep\u003c/em\u003e = 0.805), as expected by the close means of the age of successful vs unsuccessful cases (26.75 vs. 26.88). The duration of infertility, measured as the number of years between getting married and presenting to the infertility center. Those who presented before fulfilling one year of infertility were told to come back after fulfilling the required duration, as there were no difference between successful and unsuccessful cases regarding the duration of infertility (both groups had a mean of 3.98), the relationship was statistically insignificant (\u003cem\u003ep\u003c/em\u003e =0.99). These findings might be attributed to the fact that most of the women studied belonged to the same categorical age, and further studies, including more women of a wider spectrum of age categories, should be conducted. Regarding the modality of treatment, a very strong relationship was found between the type of modality and the success of the cycle, as the rate of success for intracytoplasmic sperm injection (ICSI) was significantly higher compared to intrauterine injection and ovarian stimulation (68.21% vs 29.58% vs 2.20%), with \u003cem\u003ep\u003c/em\u003e-value of 0.001.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis clinical audit is considered the first of its type at Razan Medical Center for infertility, as it will help modify and enhance the clinical practice and patient care. In addition, the large sample size helped define the actual relationships between different determinants. Being a retrospective cohort study, its results are considered relatively strong and reliable. Our study was limited by the high number of incomplete files, manifested by the fact that of the total of 459 infertile females enrolled in the study, only 291 completed their investigations, giving a rate of (63.5%). The insufficient data were in the biochemical markers of infertility included follicle stimulating hormone, and leutenizing hormone. In addition to patient non-adherence and lack of follow-up for some patients, preventing us from knowing the outcome of the treatment.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion \u0026 Recommendations","content":"\u003cp\u003eIn conclusion, we found a strong relationship between FSH and diagnosis with the success of treatment. Our most important finding was the extremely significant relationship between ICSI and positive outcome, as it was superior to both IUI and ovarian stimulation when it comes to achieving a positive end-result. We recommend starting with ICSI with patients adequate for this modality of treatment to save patient time and effort in achieving their desired results. However, this remained an obstacle given how expensive ICSI is compared to IUI. Furthermore, we recommend testing FSH hormone as routine for patient who present to IVF center.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStands for\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eAssisted reproductive technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003ePolycystic ovary syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eFSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eFollicle-stimulating hormone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eLeutinizing hormone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eThyroid-stimulating hormone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003ehPRL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eHuman prolactin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eGPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eGravida/porta/abortus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eIUI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eIntrauterine insemination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eICSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eIntracytoplasmic sperm injection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003ehCG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eHuman chorionic gonadotropin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"32.5077399380805%\"\u003e\n \u003cp\u003eIVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"67.49226006191951%\"\u003e\n \u003cp\u003eIn vitro fertilization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003ethis manuscript was reviewed and accepted by An-Najah National University International Review Board (IRB) committee\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eData essential for the conclusion are included in this manuscript. Additional data can be obtained from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003ethe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003ethe authors received no financial support for the research, authorship, and publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution:\u0026nbsp;\u003c/strong\u003eHA, DQ, and HM conceived the study. AK performed analysis. HA, DQ, and HM wrote the original draft of the manuscript. HA and AK revised the manuscript. HA wrote the final manuscript. All authors contributed to the writing and reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe would like to acknowledge Dr. Salem Abu-Khaizaran, founder and manager of Razan Medical Center for Infertility who helped during the data collection period and provided us with the necessary access.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Zegers-Hochschild F, Adamson GD, de Mouzon J, et al.: International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertility and sterility. 2009, 92:1520-1524. 10.1016/j.fertnstert.2009.09.009\u003c/p\u003e\n\u003cp\u003e2. Smith JF, Walsh TJ, Shindel AW, et al.: Sexual, marital, and social impact of a man\u0026apos;s perceived infertility diagnosis. 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Human reproduction update. 2016, 22:104-115. 10.1093/humupd/dmv044\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"An-Najah National University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Infertility, assisted reproductive technology, follicle stimulating hormone","lastPublishedDoi":"10.21203/rs.3.rs-2799972/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2799972/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eInfertility is a public health issue with a huge impact on the well-being of affected couples. Despite the traditional valuing of fertility within the Palestinian society, no studies were conducted to detect the determinants of pregnancy outcome in Palestine. This paper aims at detecting the characteristics and pregnancy outcome after assisted reproductive technology (ART) of a sample of the Palestinian society.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials \u0026amp; Methods: \u003c/strong\u003eA retrospective observational study was carried out at Razan Medical Center for Infertility. Subjects were assigned 2 categories based on the type of infertility, 7 different categories according to the cause of infertility, and 3 categories for the modality of treatment. Age at marriage, age at presentation, duration of infertility, in addition to regularity of menstruation were also studied. Biochemical pregnancy was considered the endpoint for the purpose of analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWe reviewed the files of 459 subjects diagnosed with infertility. Of the studied subjects, 79.74% had primary infertility, while 20.26% had secondary. According to diagnosis, 28.85% were found to be infertile due to anovulation, 2.86% due to endometriosis, 16.74% attributed to male factor, 3.3% had tubal damage, while 34.80% had no explainable cause. 13.43% of cases were multifactorial. Four biochemical markers were assessed in our study, thyroid-stimulating hormone (TSH) (\u003cem\u003ex̄\u003c/em\u003e=2.32±2.46), leutinizing hormone (LH) (\u003cem\u003ex̄\u003c/em\u003e=6.71±4.90), follicle-stimulating hormone (FSH) (\u003cem\u003ex̄\u003c/em\u003e=6.59±6.11), and human prolactin (hPRL) (\u003cem\u003ex̄\u003c/em\u003e=41.88±6.50). The menstrual cycle was regular in 70.58% of subjects, in contrast to 29.41% with irregular cycles. Female mean age at presentation 22.76±5.58, while their mean age of marriage was 22.76±4. Mean duration of infertility was 3.97±6.87. Patients were treated via 3 modalities, ovarian stimulation (2.2%), intrauterine insemination (IUI) (29.58%), and intracytoplasmic sperm injection (ICSI) (68.21%), with a rate of success of 51.85%. Of the studied factors, only diagnosis, FSH, and modality of treatment had a significant impact on the outcome, with \u003cem\u003ep-\u003c/em\u003evalues of 0.040, 0.003, and \u0026lt;.0.001, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ethere is a strong relationship between diagnosis prior to intervention, level of FSH and treatment modality on successful outcome of ART. ICSI was found to be superior to other modalities of treatment. We recommend starting with ICSI to save patient time \u0026amp; effort.\u003c/p\u003e","manuscriptTitle":"Determinants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2023-04-12 02:43:06","doi":"10.21203/rs.3.rs-2799972/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2023-04-11 18:18:10","doi":"10.21203/rs.3.rs-2799972/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12479671-225d-4643-a8ae-7b2a3b6ef73c","owner":[],"postedDate":"April 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":20624887,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2023-04-11T18:18:10+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-12 02:43:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-2799972","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2799972","identity":"rs-2799972","version":["v2"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}