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Table 1 Postulated mechanisms behind less favorable treatment outcome (reduced implantation rate and increased adverse obstetric outcome) after ovarian hyperstimulation

From: The role of aromatase inhibitors in ameliorating deleterious effects of ovarian stimulation on outcome of infertility treatment

Causes: Targets
1-Supraphysiological estrogen levels attained during ovarian stimulation
2-Medications used during ovarian stimulation:
•Clomiphene citrate
•Gonadotropins
•GnRH analogues: agonists & antagonists
•HCG used to trigger ovulation
3-Other probable causes: abnormal levels of other hormones, peptides and local autocrine mediators associated with ovarian stimulation
1-Endometrium
2-Developing oocyte
3-Sperm
4-Developing embryo
5-Maternal endocrine system: ovaries (corpus luteum), pituitary gland and hypothalamus.
6-Other probable targets e.g.
•Fallopian tubes
•Early developing placenta
•Leptin-mediated effects
•Coagulation system