Review

Fertility issues in women with diabetes

Anna Livshits & Daniel S Seidman†
Diabetes mellitus Type 1 and Type 2 should be considered in the differential diagnosis of menstrual
abnormalities and infertility. The reproductive period of diabetic women may be reduced due to
delayed menarche and premature menopause. During the reproductive years, diabetes has been
associated with menstrual abnormalities, such as oligomenorrhea and secondary amenorrhea. It
was found that better glycemic control and prevention of diabetic complications improves these
irregularities and increases fertility rates close to those that are seen in the general population.
Women with persistent menstrual abnormalities despite adequate treatment need to be approached
by broader evaluation, which will include the examination of the hypothalamic–pituitary–ovarian
axis and the hormonal status, presence of autoimmune thyroid disease and antiovarian
autoantibodies, and hyperandrogenism.

Diabetes is a disease that affects millions of Subsequent epidemiologic studies supported

people and their families. The WHO estimates
that more than 180 million people worldwide
have diabetes. This number is likely to more
than double by 2030 [1] .
Type 1 diabetes, which predominately affects
youth, is rising alarmingly worldwide, at a rate of
3% per year. Some 70,000 children aged 14 and
under develop Type 1 diabetes annually. Type 2
diabetes is also increasing in number among
children and adolescents as obesity rates in this
population continue to soar, in both developed
and developing nations [101] .
Diabetes affects women in many ways,
and one of them will be the focus of the pres-
ent review – the association between diabetes
m­ellitus and infertility (Box 1) .
Menarche & menstrual cycle
disturbances in Type 1 diabetes
Before the first introduction of insulin in clinical
care of Type 1 diabetes in 1922, menarche rarely
occurred in girls with diabetes during childhood,
and when it did occur, menses usually ceased.
Successful pregnancy was achieved in only 2%
of Type 1 diabetic women [2] . Initiation of insu-
lin treatment caused menstruation to appear in
most female diabetic patients, but did not abol-
ish menstrual irregularities. Earlier studies from
1954 by Bergqvist showed delayed menarche
among women with the onset of diabetes before
menarche and controlled for their diabetes mel-
litus as outpatients, together with persistent
menstrual disorders remaining in the third and
forth decade in 30% of those women [3,4] . The
prevalence of these disorders, mainly secondary
amenorrhea and oligomenorrhea, was shown to
be three-times more frequent compared to non-
diabetic controls in the study by Rzepka et al.
in 1977 [5] .
the fact that diagnosis of Type 1 diabetes prior
to menarche, particularly before 10 years of age,
caused a delay in menarchial age of approximately
1 year when compared with control [6] . Similar
results were obtained in studies conducted in
different demographic populations. Moreover,
a correlation was found between the menar-
chial age delay and the presence of menstrual
irregularities [7,8] . Kjaer et al. found menstrual
dysfunction to be twice as frequent in diabetic
women compared with nondiabetic controls (21.6
vs 10.8%) [47] , which is lower than reported by
Begqvist, but no less bothersome. In addition,
in Strotmeyer’s study, Type 1 diabetes was inde-
pendently associated with longer cycle length
(>31 days), long menstruation (≥6 days), heavy
menstruation, and more reports of any menstrual
problem at the younger age ranges (<29 years) [5] .
As women moved closer to the end of their repro-
ductive years, the differences found by diabetes †
Author for correspondence
status were no longer significant. Department of Obstetrics &
Gynecology, Chaim Sheba
Hypothalamic anovulation & Medical Center, 52621
Type 1 diabetes Tel-Hashomer, Israel
The above described observations may reflect Tel.: +972 360 4659
a general dysfunction of the hypothalamic– Fax: +972 35 35 2081
dseidman@tau.ac.il
p­ituitary–ovarian (HPO) axis (Figure 1) [102] .
The effect of Type 1 diabetes on the repro-
ductive endocrine axis can be conceptualized Keywords
as anorexia-like hypothalamic anovulation.
Diabetic women with low BMI are more likely • diabetes mellitus Type 1
• diabetes mellitus Type 2
to have menstrual irregularities [7] . There are
• fertility • infertility • menarche
katabolic processes in young diabetic girls and • menopause • menstrual
nutritional restriction leads to intracellular starva- irregularities
tion, especially before the diagnosis and initiating
insulin treatment. This may subsequently cause
disruption in hypothalamic pulsetile secretion of part of
gonadotrophin-releasing hormone (GnRH), with
a resultant decrease in gonadotropins secretion.

10.2217/WHE.09.47 © 2009 Future Medicine Ltd Women's Health (2009) 5(6), 701–707 ISSN 1745-5057 701
Women’s Health – Livshits & Seidman
Box 1. Infertility risk factors related to diabetes mellitus.
• Menstrual abnormalities
• Shortening of reproductive period (late menarche and premature menopause)
• Poor glycemic control and presence of diabetes complications
• Hyperandrogenism and polycystic ovary syndrome
• Autoimmunity (Hashimoto’s thyroiditis and antiovarian autoantibodies)
• Sexual dysfunction
In diabetic animal studies conducted by
Johnson and Sidman in 1979, it appeared
that the main etiologic factors associated
with impaired hypothalamus–pituitary func-
tion were indeed inadequate release of GnRH
and/or reduction in the sensitivity of the pituitary
gland to GnRH [9] . Studies in women by Djursing
et al. in 1983 and 1985 detected lower basal levels
of luteinizing hormone (LH) in Type 1 diabetic
patients with amenorrhea, and showed different
reactions of LH to exogenous GnRH, thus sug-
gesting that menstrual disturbances in Type 1 dia-
betic patients are mainly of hypo­thalamic o­rigin
rather than primary pituitary dysfunction [10] .
Neuroendocrine control must also be con-
sidered when interpreting disturbances in the
HPO axis [11] . It was reported by Djursing that
Type 1 diabetic women had lower basal prolactin
levels, unrelated to the presence of menstrual
disorders. However, only diabetic amenorrheic
patients had a decreased prolactin response to
dopamine antagonists. These results suggest
that diabetic patients with menstrual disorders
may have increased central dopaminergic activ-
ity, which in turn inhibits GnRH secretion.
Endogenous opium-like peptides – endorphins
– also have an inhibitory effect on GnRH release
[11] . It is believed that gonadotrophin secretion is
regulated by an interaction between dopamine
and endogenous opioids. Nevertheless, a pre-
vious study by O’Hare et al. in 1987 failed to
demonstrate a change in gonadotophic levels or
initiation of menstruation after administration
of the opioid inhibitor naloxon in hypogonado-
trophic amenorrheic Type 1 diabetic women [12] .
Finally, an association between Type 1 diabetes
and polycystic ovary syndrome (PCOS) was
reported in a recent study by Codner et al. [13] .
These authors found that vigorous treatment
with insulin, frequently applied in Type 1 dia-
betes in order to prevent diabetic complications,
may lead to supraphysiolgical doses of insulin,
subsequently initiating hyperandrogenism and
PCOS. In addition to exogenous hyperinsulin-
ism, insulin resistance is also possible in women
with Type 1 diabetes, owing to decreased glucose
uptake by the muscle. That also contributes to
702 www.futuremedicine.com
the development of androgen excess in women
with Type  1 diabetes. Codner et al. detected
increased l­evels of total and free testosterone,
increased LH to follicle-stimulating hormone
ratio, larger ovarian volumes and abnormalities
in ovarian morphology [13] . This was especially
prominent among women with the onset of
Type 1 diabetes before menarche. PCOS preva-
lence of 31 and 40% were reported using the
Androgen excess society criteria and Rotterdam
criteria, respectively [14,15] , among Type 1
d­iabetic women in Codner’s study [13] .
Correlation between Type 2 diabetes
& fertility
Most of the Type 2 diabetes female patients are
postmenopausal women, but with changing
dietary and lifestyle patterns, the prevalence of
obesity is increasing, thus raising the incidence
of Type 2 diabetes during the reproductive years.
There is an association between Type 2 diabe-
tes and fertility, alterations in the length of the
menstrual cycle, and the age of onset of meno-
pause [16] . This association may be explained by
linking this disease to PCOS, the most common
hormonal disorder among women of repro­
ductive age, and a leading cause of infertility.
Insulin resistance, obesity and diabetes melli-
tus strongly correlate with PCOS. Both PCOS
and Type 2 diabetes have the same risk factors,
such as hypertension, obesity, dyslipidemia and
hyper­insulinemia. Hyperinsulinemia results from
insulin resistance, which through alterations in
the level of IGFBP, IGF1 and SHBG stimulates
increased androgen secretion at the adrenal gland
and the ovary, subsequently causing anovulation.
Legro et al. showed that PCOS women are at sig-
nificantly increased risk for impaired glucose tol-
erance and Type 2 diabetes mellitus at all weights
and at a young age [17] . They also found that these
prevalence rates are similar in two populations of
PCOS women with different weights, suggesting
that PCOS may be a more important risk fac-
tor than ethnicity or race for glucose intolerance
in young women. By contrast, a study by Amini
et al. showed that PCOS is highly prevalent in
Type 2 diabetic patients [18] .
future science group
 Fertility issues in women with diabetes – Review

Obesity is common in both PCOS and
Type  2 diabetic women. Studies show that
obese women seeking pregnancy experience
longer times to conception, unrelated to age
and to cyclic regularity, which is suggestive of
alterations in ovarian function during the peri-
conceptual period [19,20] . Metwally et al. found
that oocytes from women with increased BMI
gave rise to blastocyts of poorer quality  [21] . A
recent study presented an analysis of the o­varian
follicular environment of women across a large
range of BMIs, by measuring f­ollicular fluid
hormones and metabolites, as well as g­ranulosa
and cumulus cell gene expression [22] . The study
demonstrated elevated intrafollicular insulin
and triglycerides, and increased e­xpression of
lipoprotein receptors in overweight and obese
women. Gene expression alterations were not
affected by BMI. In addition, there was an
increase in free androgen profile within the
ovarian follicles of obese women, as well as an
increased level of C-reactive protein, which
may be associated with the poorer reproductive
o­utcomes typically observed in these patients.
Finally, systematic review on pregnancy and
fertility following bariatric surgery showed
that some normalization of sex hormones and
m­enstrual irregularities, as well as improve-
ment in PCOS, has occurred. However, the
influence on fertility still needs to be further
studied [23] .
Limited conclusions could be made regarding
the influence of diabetes on fertility, since the
studies described above are based on a small num-
ber of patients. They also addressed m­enstrual
problems alone, without long-term follow- up on
fertility rates among patients with Type 1 diabetes
in relationship to their g­ycemic control.
The first population-based epidemiological
study on fertility rates over time among women
with Type 1 diabetes was conducted in Sweden
during 1965 to 2004 [26] . The study followed up
on 5978 Type 1 diabetic women diagnosed at
16 years of age or younger, who were identified in
the Swedish Inpatient Register, until 48 years of
age, death or emigration. A standardized fertility
Catecholamines
Hypothalamus
Endorphins
Arcuate nucleus
GnRH
Pituitary gland
Prolactin
FSH Posterior

LH
Association of modern management of Anterior
diabetes mellitus Type 1 with decrease
in infertility Intermediate
In the past, the relationship between menstrual
dysfunction and diabetic control was considered
controversial. Kajer et al. showed an associa-
tion between low BMI, high concentrations of
HbA1C and the presence of menstrual irregu- Estrogen
larities [7] . Yeshaya et al. found that patients with
diabetic complications had a higher incidence Ovary
of menstrual disorders compared with diabetic
patients without complications [6] . Schroeder
et  al. examined the correlation between the
degree of glycemic control in Type 1 diabetic Progesterone
adolescents and menstrual regulation [24] . They
reported that tighter glycemic control, measured
by lower levels of HbA1C, was associated with Inhibin
improved menstrual regulation. Other stud-
ies failed to demonstrate a relationship with
the metabolic state (high BMI, microvascular
and macrovascular complicatrions, or high
HbA1C  [8] . There have even been reports sug-
gesting good metabolic control among women
with oligo/amenorrhea [25] . Figure 1. Hypothalamus–pituitary–ovarian axis.

future science group Women's Health (2009) 5(6) 703

Women’s Health – Livshits & Seidman
ratio (SFR; the ratio of observed to expected
number of live births, with 95% CIs), was used
to express the relative fertility rate. The num-
ber of live births was 4013, which was smaller
than expected (SFR 0.80 [95% CI: 0.77–0.82]).
The lowest SFRs were observed among women
who had their first hospitalization for diabetes
in the earliest years. SFRs increased monotoni-
cally with calendar year of first hospitalization to
become statistically indistinguishable from 1.0
after 1984. The presence of diabetic microvas-
cular or cardiovascular complications was asso-
ciated with particularly low fertility, essentially
regardless of year of first hospitalization (Table 1) .
Overall, fertility among Type 1 diabetic
women was reduced by 20% in this study, com-
pared to the matched general Swedish female
population, with the lowest SFRs in the earlier
years. This was followed by a significant increase
in SFR until normalization among women with
uncomplicated disease and an onset in the past
20 years. The increase in fertility after 1985 was
independent of complication status, age at first
hospitalization or duration of diabetes, and thus
was probably attributed to better interventions in
treatment. Although improvement was evident
regardless of status of diabetes complications,
women with complications always had lower
fertility than those without these complications.
The results of this study suggest that the
stricter metabolic control exercised in the past
20 years, together with better control of blood
pressure and more frequent use of drugs active in
blocking the renin–angiotensin system, has also
been s­uccessful with regard to preserving fertility.
Menopause
It has been known that patients with diabetes
mellitus experience changes of cell senescence
earlier than the general population. This could
indicate that one such sign of aging in women,
menopause, may occur earlier compared with
nondiabetic women.
Table 1. Standardized fertility ratios among women hospitalized for Type 1 diabetes
at ≤16 years of age, stratified by type of complications (1965–2004, Sweden).
SFR for Type 1 diabetic
Diabetic complications women without complication with complication
Retinopathy 0.84
Nephropathy 0.82
Neuropathy 0.81
Cardiovascular 0.80
SFR: Standradized fertility ratio.
Modified from [26].
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A study conducted by Dorman et al. among
Caucasian women with Type 1 diabetes com-
pared the age at menopause of 143 women with
Type 1 diabetes, to their nondiabetic sisters and
unrelated nondiabetic controls [27] . They found
that the mean age was significantly younger for
Type 1 diabetic women. Women with Type 1 dia-
betes were approximately twice as likely to have
experienced menopause earlier than similar non­
diabetic women. In particular, patients with early
menopause were younger at Type 1 diabetic onset
(8.6 vs 12.6 years of age; p = 0.10). Multivariate
analysis confirmed that Type 1 diabetes was an
independent determinant of early menopause
(HR: 1.98; p = 0.056). In the same study, the
age of menarche was found to be significantly
older for Type 1 diabetic women compared with
nondiabetic women; taken together with pre-
mature menopause, this therefore reduces the
r­eproductive period in Type 1 d­iabetic women
by 6 years.
Strotmeyer et al. found the age of natural
menopause in Type 1 diabetic women to be
almost 10 years earlier compared with nondia-
betic sisters and unrelated nondiabetic controls [5] .
The mean age of self-reported natural menopause
in Type 1 diabetic women was 42 years, however
perimenopausal symptoms were already observed
in women in their t­hirties and forties.
Regarding women with Type 2 diabetes, few
studies have so far been conducted. The only
study that we found did not show increased risk
for premature menopause. López-López R et al.
compared 409 women without diabetes and 404
women with Type 2 diabetes and found no dif-
ference for age at menopause between these two
groups [28] .
Premature menopause in Type 1 diabetic
women may also be related to the autoimmu-
nity aspects of Type 1 diabetes. Goswami et al.
found higher prevalence of thyroid peroxidase
autoantibodies in patients with premature ovar-
ian failure compared with healthy controls [29] .
SFR for Type 1 diabetic women
0.63
0.54
0.50
0.34
future science group

The possible autoimmune etiology of infertility
related to Type 1 diabetes will be discussed in
the next section.
Autoimmunity
Autoimmune diseases, including oophoritis,
orchitis and hypothyroidism, are well-known
causes of infertility. Autoimmune oophoritis
may occur as part of type I and type II syn-
dromes of polyglandular autoimmune failure,
which are associated with autoantibodies to
multiple endocrine and other organs. Young
women with spontaneous premature ovarian
failure are at increased risk of autoimmune
hypothyroidism and should be screened for
this condition.
Type 1 diabetes and autoimmune thyroid
diseases frequently occur together within fami-
lies and in the same individual. Therefore, we
can assume that patients with Type 1 diabetes
that have overt or concealed hypothyroidism
may also be at risk for premature ovarian fail-
ure. In general, evaluation of premature ovar-
ian failure should include serum concentration
of follicle-stimulating hormone and estradiol
and screening for asymptomatic autoimmune
adrenal insufficiency, since it is more common
in women with autoimmune ovarian failure. In
addition, testing should include thyroid-stimu-
lating hormone, free T4, antithyroid-peroxidase,
antithyroglobulin antibodies and karyotype.
Menstrual cycle changes observed in patients
with Hashimoto’s thyroiditis include menor-
rhagia, more frequent and longer periods, and
dysmenorrhea. Prevalence of thyroid autoim-
munity is significantly higher among infertile
women than among fertile women, especially
among those whose infertility is caused by
­endometriosis or ovarian dysfunction [28] .
In a study conducted by Strotmeyer et al. more
than 40% of women with Type 1 diabetes had
Hashimoto’s thyroiditis [8] . Nevertheless, he did
not find menstrual disorders to be significantly
affected by Hashimoto’s thyroiditis. It could be
reasoned that in some of the women, Hashimoto’s
thyroiditis was diagnosed much later after men-
strual disorders occurred. Others had their thy-
roid disease under adequate control, and were less
likely to exhibit menstrual irregularities.
Snajderova et al. studied the presence of organ-
specific autoantibodies and other endocrine
autoimmune disorders in girls with Type 1 dia-
betes [30] . They found ovarian autoantibodies in
67.9% of Type 1 diabetic girls compared to 4.8%
of healthy controls (p < 0.01). Autoantibodies
directed to ovarian steroid-producing cells were
future science group Women's Health (2009) 5(6)
Fertility issues in women with diabetes – Review
frequent in diabetic girls with both irregular and
normal menstrual cycles.
The role of thyroid involvement in diabetes
Type 1 patients and its effect on menstruation
cycle and fertility has been well observed. More
studies, however, are needed to explore the cor-
relation between Type 1 diabetic women and the
presence of antiovarian autoantibodies among
these women, with relationship to infertility.
Sexual dysfunction & diabetes
It is been estimated that approximately 35–75%
of men with diabetes will experience at least
some degree of erectile dysfunction during their
lifetime [103] . They tend to develop erectile dys-
function 10–15 years earlier than men without
diabetes. The effect of diabetes on female sexual
function was not fully recognized and addressed
in the past. Enzlin et al. reviewed 15 studies con-
ducted between 1971 and 1996 [31] , and docu-
mented that the prevalence of impaired sexual
arousal and inadequate lubrication was between
14–45% among diabetic women, significantly
higher than in healthy controls [31] . In a subse-
quent controlled study that they conducted in
2002, Enzlin et al. found that more women with
diabetes than control subjects reported sexual dys-
function (27 vs 15%; p = 0.04) [32] . Female sexual
dysfunction may have a secondary effect on fertil-
ity by decreasing sexual desire and limiting sexual
activity, especially around the time of ovulation.
Future perspective
Improved glycemic control was found to be asso-
ciated with improvement in menstrual abnormali-
ties and in fertility rates [6,7,24,26] . Nevertheless,
some diabetic patients experience persistent men-
strual irregularities even though good metabolic
control has been achieved. In those patients, it
is worthwhile to address the possible abnormali-
ties in the HPO axis and to evaluate their hor-
monal status (GnRH, LH, follicle-stimulating
hormone and GnRH stimulation test), as well
as the a­utoimmune etiology related to diabetes.
At present, most of our knowledge on auto­
immunity aspects of Type 1 diabetes and its effect
on fertility in diabetic women is mainly related
to the presence of Hashimoto’s thyroiditis or thy-
roid peroxidase autoantibodies. Few studies have
explored the presence of antiovarian autoantibod-
ies and its clinical significance in Type 1 diabetes
patients. Snajderova showed a higher prevalence
of these antibodies in Type 1 diabetic girls [30] ,
but there has not been further follow-up. More
studies need to be conducted in order to examine
the correlation between Type 1 diabetic patients
705
Women’s Health – Livshits & Seidman

and the presence of antiovarian autoantibodies.
Additional questions remain whether antiovarian
autoantibodies are associated with infertility, and
whether tight glycemic control may decrease or
eliminate their prevalence.
Premature menopause observed more com-
monly among diabetic women is also a mystery
that remains to be solved. Several explanations
have been proposed, among them the antiovar-
ian autoantibodies, prolonged hyperglycemia
and hyperandrogenism induced by insulin
treatment. Future studies should be conducted
to evaluate the relationship between better
metabolic control and the age of menopause in
d­iabetic patients.
Finally, we mentioned the possible effect that
diabetes may have on the incidence and the sever-
ity of upper genital tract infections. Few stud-
ies have been reported until now exploring this
field, and this possible association and its effect on
­fertility definitely deserve further research.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involve-
ment with any organization or entity with a financial interest
in or financial conflict with the subject matter or materials dis-
cussed in the manuscript. This includes employment, consultan-
cies, honoraria, stock ownership or options, expert testimony,
grants or patents received or pending, or royalties. No writing
assistance was utilized in the pr­oduction of this manuscript.

Executive summary
Delayed menarche & menstrual irregularities in Type 1 diabetes
• Diagnosis of Type 1 diabetes mellitus (DM) prior to menarche, particularly before 10 years of age, caused a delay in menarchial age.
• If the onset of Type I DM precedes menarche, it is often delayed and patients are more likely to develop menstrual disturbances.
• This may reflect a general dysfunction of the hypothalamic–pituitary–ovarian (HPO) axis: disruption in hypothalamic pulsetile secretion
of gonadotropic releasing hormone (GnRH), lower basal level of luteinizing hormone (LH) and different reactions of LH to exogenous
GnRH in women with Type 1 diabetes with menstrual disorders.
• Too vigorous treatment with supraphysiological doses of insulin may contribute to the etiology of menstrual disorders in women with
Type 1 diabetes by causing hypedandrogenism and polycystic ovary syndrome (PCOS).
Type 2 diabetes & infertility
• Type 2 diabetes is associated with infertility, alterations in the length of menstrual cycle, and the age of onset of menopause.
• This may be explained by the correlation of Type 2 diabetes to PCOS, which is highly prevalent in women with Type 2 diabetes.
• Obese women experience longer times to conception, even if they are young and cycling regularly, which is suggestive of alterations in
ovarian function during the periconceptual period.
Association of modern management of diabetes mellitus with a decrease in infertility
• Poor glycemic control and the presence of diabetic complications are associated with menstrual irregularities and lower fertility.
• A population-based epidemiological study on fertility rates over time among Swedish women with Type 1 diabetes during 1965 to
2004 showed a reduction in fertility by 20%. The presence of diabetic microvascular or cardiovascular complications was associated
with particularly low fertility.
• Increase in fertility was evident in the past 20 years and could be attributed to stricter metabolic control.
Menopause
• Type I diabetes may be associated with a higher incidence of premature menopause.
• Patients with early menopause were younger at the onset of Type 1 diabetes.
• Premature menopause in women with Type 1 diabetes may be related to autoimmunity aspects of Type 1 diabetes.
Autoimmunity
• Hashimoto’s thyroiditis is highly prevalent among patients with Type 1 diabetes (some studies reported >40% prevalence).
• Menstrual cycle changes observed in patients with Hashimoto’s thyroiditis include menorrhagia, more frequent and longer periods,
and dysmenorrhea.
• Antiovarian autoantibodies were found in girls with Type 1 diabetes in higher frequency compared with healthy controls.
Sexual dysfunction & diabetes
• Higher prevalence of impaired sexual arousal and inadequate lubrication was found to be significantly higher in women with Type 1
diabetes compared with healthy controls.
Future perspective
• We must improve our understanding of the HPO axis and the hormonal balance in women with diabetes with persistent menstrual
abnormalities despite good glycemic control.
• Establish the prevalence of antiovarian autoantibodies in Type 1 diabetes, their association to infertility, and the effect of good glycemic
control on their presence.
• Find out the incidence and severity of upper genital tract infections in women with Type 1 and 2 diabetes compared with nondiabetic controls.
• Evaluate whether better treatment of diabetes may reduce the incidence of premature menopause in diabetic women.

706 www.futuremedicine.com future science group


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Affiliations
• Anna Livshits, MD
Department of Obstetrics & Gynecology,
Chaim Sheba Medical Center,
52621 Tel-Hashomer, Israel
Tel.: +1 414 791 6817
Fax: +1 262 309 2671
anatlivs@gmail.com
• Daniel S Seidman, MD, MMSc
Department of Obstetrics & Gynecology,
Chaim Sheba Medical Center,
52621 Tel-Hashomer, Israel
Tel.: +972 360 4659
Fax: +972 35 35 2081
dseidman@tau.ac.il
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