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Table 2 Deleterious effects of the supraphysiological estrogen levels attained during ovarian stimulation:

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

1-Effect on the endometrium: most of the available evidence
a: Dys-synchronization of the implantation window.
b: Abnormal Temporal expression of the endometrial pinopodes.
c: Defective endometrial estrogen and progesterone receptors.
d: Impaired endometrial blood flow
e: Abnormal endometrial integrins expression
2-Effect on the developing oocyte
a: Effect on chromosomal and cytogenetic integrity of the oocyte
b: Effect on the mitochondrial function
3-Effect on the sperm causing possible premature acrosome reaction and deactivation
4-Effect on the developing embryo and blastocyst hatching
5-Effect on the ovaries and pituitary (defective corpus luteum function and luteal phase):
a: Defective LH secretion:
- Abnormal LH surge
- Abnormal LH tonic pulse
b: Defective corpus luteum function
6-Other probable targets:
I-Leptin
II-Coagulation system: III-Fallopian tubes
• a: Effect on the ductal environment and ductal fluid
• b: Effect on the ductal transfer and motility
IV-Early developing placenta