Hans van der Slikke, MD, PhD

  “We are at ESHRE 2003 in Madrid,  Spain and we have here Dr. Basil Tarlatzis from Greece and Dr. Bart  Fauser from Holland and they talk this afternoon about the new  guidelines for PCO and PCOS.  Welcome gentlemen! Could you give a little  summary, in a few words, of the main diagnostic criteria and  nomenclature you talked about?” 
 
 

  “Now the three criteria that will appear in the new guidelines are the clinical picture of abnormal ovarian function: 
 
 1) oligoamenorrhoea
 2) any form of hyperandrogenemia, either clinical, being hirsutism, acne  or endocrine which means the hormonal diagnosis of high androgen  levels, and 
 3) the ultrasound picture of polycystic ovaries. 
 
 Those three are the major criteria but it’s important to realise that in  order to make the diagnosis it doesn’t need to fulfil all three  criteria but only two out of three.  That makes it into a heterogeneous,  so if you have polycystic ovaries and hyperandrogenemia you don’t need  to have cycle abnormalities for the diagnosis.  Or if you have cycle  abnormalities and polycystic ovaries you don’t need hyperandrogenemia  for the diagnosis. 
 
 So I think that’s a real advancement in terms of way you are thinking  because as gynaecologists usually we are not used to that kind of  thinking although in other specialties that’s pretty common.  Indeed I  think it’s the ultimate: it’s a syndrome.  We know that not a single  symptom or sign is mandatory for the diagnosis and that’s usually still  how our mind works.  We want to see it in black and white.  It should be  there or it shouldn’t but here sometimes it can be but it doesn’t have  to.”
 
 

  “This is important because it’s  not a disease of importance for gynaecologists only but it is a serious  disease for long-life diabetes, cardiovascular disease maybe?”
 
 

  “Yes!  Right!  Therefore they may  visit a cardiologist, they may visit an endocrinologist, a medical  endocrinologist, paediatrician if they are relatively early with their  complaints, a dermatologist because of hirsutism, so they have very  different phenotypes.  And depending on age, indeed they may go on with  obesity problems, and signs of early diabetes. 
 
 The key issue and the problem is, and the major controversy has been,  the ultrasound.  That started in the UK.  All the first papers were from  the United Kingdom, and they were widely accepted I think in major  parts of the world, except North America and that still is the case.   It’s still clear, and what we’ve done now is try to unify in order to  make something workable for everyone.  Clearly now too we got criticised  this afternoon because some people were saying, “Yes but ultrasound  should be mandatory. I would never diagnose a PCOS without the  ultrasound picture.”   And two weeks ago in the US there were quite some  complaints, people there were saying, “We don’t need ultrasound at  all.”  So it’s interesting.  Now you see we all have our own perceptions  and world and cultural things and if we can really get it to work, get  it on paper supported by all the participants and then get it published I  do believe it’s a clear step forward.”
 
 

  “Dr Tarlazis?  How many Americans participated in this workshop?”
 
 

  “Approximately 10, almost half of  the participants, and they were the leading figures working in the  field.  Of course we had very intense discussions because, as Professor  Fauser said, the problem is that   they have focused mainly on the  menstrual ovulatory irregularities and the high androgens, but we know  that, as I said, the phenotype PCOS is variable, so you may have high  androgens without menstrual irregularities but on an ultrasound,  polycystic ovaries. 
 
 And then, if this woman gains a few kilograms or pounds, she becomes  irregular in her menses.  Hence, the syndrome is there, but you may see  it at a different phase in her life.  Therefore, we tried to be as  inclusive as possible, namely to include all possible phenotypic  disorders in order to be able to understand what is happening with the  disease and move forward to its aetiology. Obviously, that was the  difficulty.  When such a thing is being proposed, as Professor Fauser  said, you face opposition from both sides. I mean, those who have been  used to use ultrasound only, they say, “Why do you need all these  androgen measurements and stuff?”  If on the other hand, you speak with  the American colleagues who have been used to use only the blood  measurements and very elaborate endocrine tests, they say, “Why do you  need the ultrasound?”  The fact that the complaints come from both sides  means that we are on the right track. 
 
 The second thing that we tried to do, and which will hopefully appear on  the paper, was to set criteria, because indeed both the measurement of  the androgens but also the ultrasonographic evaluation of the ovaries,  have pitfalls.  Thus, in the paper we will put some guidelines again on  how we should determine ultrasonographically that an ovary is polycystic  and the same we will try to do for the androgen determinations”.
 
 

  “Actually there was a clear consensus there which I think already is a step forwards.”
 
 

  “Indeed, and ultrasonography, ovarian volume should be the feature because  it is simple and  the  current equipment, can automatically calculate ovarian volume, if you  properly measure the three dimensions.  Thus, we can have a more  objective   measurement.  And for the androgens we will also have some  guidelines on which tests to use and what are their limitations.”
 
 

“It’s going to help it and I think  it’s going to stimulate certain developments and it’s certainly going to  put more emphasis on certain androgen assays which will be developed  further as being the most reliable marker.”
 
 

  “It is extremely important to be as  precise as possible, because trying to diagnose such a variable syndrome  with tests that are not objective and accurate, you can imagine, ends  up in chaos.”
 
 

  “Not only for treatment but also for science and for evidence based medicine.”
 
 

Associate Professor Basil C Tarlatzis, MD, PhD:

  “And for advances in the field because  you can, obviously you can build a house with bricks and stones but if  the foundation is not good then it’s not going to work after all.  And  that’s the fear obviously that people are doing so many different things  and later on you have to start from scratch again.  So now we try to  work on the foundation to make that more solid.  From there on we can  build again.”
 
 

  “It’s very good.  I congratulate you both on the results of these beautiful consensus.”
 
 

  “It’s going to be published both in  Fertility and Sterility and Human Reproduction at the same time.”
 
 

 “Hopefully by the end of the  year.”
 
 

  “This will be great. Thank you both very much.”

Articles

OBGYN.net Conference Coveragefrom the 19th Annual Meeting of ESHRE - Madrid, Spain

PCOS: What is the Diagnostic Criteria?

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          "It's the third of July in 2001, and we're in Lausanne at the  ESHRE Conference.  Next to me is Professor Hans Evers from Maastricht  and he will be the next president of ESHRE.  Good morning,       Hans."
       
       

  "Good morning."         
       
       

         "You were so kind to give us a little overview of the highlights  of this 17th ESHRE Conference.  What do you think are the most  impressive presentations you saw?"
       
       

 "I'm a  clinician so you have to allow me some leeway but I visited  predominantly clinical sessions and I was impressed by many papers on  external effects on reproduction.  We have always thought that some  factors might influence, for example, sperm quality, oocyte quality, and  fertilization but now it's getting more and more obvious and clear that  amongst those factors are really household items like smoking and being  overweight.  The overweight issue has especially been found out quite  nicely at this meeting.  There is such a strong correlation between  overweight and effects in natural reproduction and also in IVF that the  best way to advise a woman who is overweight is to lose weight.  It's  much better, much more efficient, and much more cost effective than any  of the new reproductive medicine treatments.  I was impressed by the  results there. 
       
       The same holds for smoking; we have always thought that smoking is  not good for you and we know of several diseases related to smoking but  fertility also is effected in such a heavy way that fertilization  results in IVF may be halved in people who smoke….  That's surprising  even to me and so I was surprised to see it, and I can say positively  surprised because it's good that we ban smoking.  I hope that in this  way by losing weight and by stopping smoking that patients can  contribute so much to their treatment that either the treatment is no  longer necessary or at least they have the emotional feeling that they  have contributed in a major way to the success which they do of       course."

"It seems you're talking now about women but yesterday  one of the keynote lecturers, Professor Skakkebaek from Denmark, talked  about the environmental influence on male sperm."
       
       

  "Yes,  that's another aspect which is becoming more and more exciting, it's an  aspect that we have always neglected a little bit because you could  always argue that studies from the 1950's and from the 2000's are not  comparable because the methods of investigating sperm were different  then and now.  What Skakkebaek showed is that in long-term studies in  the same laboratory with the same technicians and without much variation  among the technicians you see a decline in sperm quality.  He could  also relate it to other problems in the male genital tract; he could  show abnormalities of the testes, the penis, and problems in early use  related to the urogenital track in little boys that at an adult age were  reflected in low sperm counts and infertility in males as well.  They  have a quite clear hypothesis that the substitutes that we take in our  daily food and environmental factors that come to us via air- and water  pollution are the main causes of this decrease so they are continuing  these studies but it's obvious.  That was what the impression of the  public was in the audience that they are on the right track and that we  should really fear for a decrease in reproductive capacities both in men  and in women."
       
       

   "After Skakkebaek there was another lecture which made it clear that  influences on the embryo are already very important for later life."
       
       

  "Yes,  that was by Professor Barker from Southhampton.  It's a theory that has  been around for quite some time already and the problem with the Barker  theory is that people are shooting more and more holes in it.  In the  beginning it sounded very fascinating that women who got small children  and when the children grew up they had more cardiovascular problems.   It's getting more and more clear that it is not that simple.  There has  been a follow-up study of the women giving birth to these children and  these women have a seven-fold increase in hypertension and cardiac  problems.  So it may even be that there is a genetic component and that  is correlated with the result and it's not being small as a baby which  determines your later life problems but there is a gene in the family  which makes on one hand the mother becoming pre-eclamptic and giving  birth to small babies and on the other hand is inherited by the baby to  give it problems.  So it's not quite clear for me that this hypothesis  is still valid but people are working on it and it is an interesting  hypothesis but it may be of less significance in the near future."
       
       

   "This afternoon the results of the consortium on IVF in Europe will be  published again after the first draft, one could say, in Bologna last  year.  Can you tell us something about this consortium?"

   "Yes, I've seen the results, the consortium is composed of members  from all membership countries of ESHRE in so far as those countries have  representative figures.  What they do is they collect the figures on a  national basis and then add them up on a European basis.  What you see  is that this consortium, which gathers two times a year to coordinate  the efforts and to present the data shows very clearly, as opposed to  the United States, in Europe there is a clear tendency towards the  replacement of fewer embryos.  We have been extremely annoyed in the  first report by the high number of multiple pregnancies, which is a  disaster, as opposed to the United States where the tendency is to put  back more and more embryos to increase the success rates and to give the  patients what they pay for.  Fortunately in Europe we are much more  modest and we realize that multiple pregnancy is not what we're suppose  to have; our women don't have a uterus that can support a twin easily.   What you see is that in the Northern countries of Europe one has gone  back from three to two to even single embryo replacements as an average  and in the south of Europe it still is a little bit lagging behind  but  they are now gradually going back from three to two.  The result is that  although the pregnancy figures remain almost the same compared to the  first report, the multiple pregnancy figures are finally declining  although they are still quite high in some countries of Europe.  It's a  little bit of a problem to see that in some countries the overall  results can only be good at the cost of a 40% multiple pregnancy rate,  whereas, for example, in Finland they have excellent results with less  than 10% multiple pregnancies and that's due to the good selection of  embryos and the elective single embryo transfer."
       
       

  "So this will be presented by Professor Nygren?"
       
       

  "Any other highlights we can expect today or tomorrow?"
       
       

  "Of  course, there are many highlights on the basic science fields.  The  cloning issue is all over this meeting and the replacement of older eggs  and rejuvenating the older eggs.  Of course, that's an effort that  everyone is interested in especially because we know that there is a  certain group of women who have aging of the eggs in a rather fast way  so in their thirties they already have eggs that are very difficult to  fertilize.  If you can improve the quality of those eggs without  effecting their genetic component, that would be a big issue.  The  problem there is that it can be misused and that's one of my main goals  during my presidency.  I am so strongly opposed to misuse of  reproductive techniques by all kind of crooks that are around us and  that use these techniques to raise hopes in infertile couples that are  not justified.  What I hope to achieve in these two years is that we get  a decent group of fertility experts in Europe that use these techniques  and that can prove that they are worthwhile of the trust of the public  but we should get rid of all these people trying to clone human beings  or to make pregnancies in sixty-two year old women only for the money."
       
       

  "I think this is a very good message to end this interview.  Thank you very much, Hans."
       
       

OBGYN.net Conference CoverageFrom the ESHRE 2001 Conference - Lausanne, Switzerland

Presentations at ESHRE

          "Good morning, it's July 3, 2001 and we're at ESHRE in Lausanne.   Next to me is Jorgen Persson who is the Product Manager of Ferring.   Good morning, Jorgen."
       
       

  "I  want to talk with you about ESHRE as it is now and especially about the  symposium that Ferring had.  Can you tell us what the headlines of this  symposium were?"
       
       

  "Yes, the  headlines from the symposium were that we wanted to show the role of LH  and the importance to include LH into treatment of       any ovulation induction, IVF, and ART.  We had some new data  coming up from a recent largest study comparing highly purified HMG  Menopur® and Gonal-F®."
       
       

  "Is this the German study?"
       
       

  "This is a  multinational study so there was some sent to us from Germany as well  the Netherlands, the UK, Israel, and some other markets as well."
       
       

  "How many cycles were there?"
       
       

  "There were 727 cycles so it's the largest study so far."
       
       

  "What are the results of this study?"
       
       

  "The results showed that Menopur® is at least as effective as Gonal-F® in the treatment of IVF and ICSI patients."
       
       

  "What about side effects?"
       
       

  "The side  effects are comparable so you get the same treatment, and you could see a  trend in the study but this should be published further on in  journals."
       
       

  "We  can refer to the interview that we also have with the presenter of this  study.  Were there other papers that you presented in your symposium?"
       
       

  "Yes, we had a  very nice presentation from Dr. Lucas Klentzeris from the UK.  He  showed his results with Doppler examination of the women in the  development of their oocytes or follicles, I should say, and that was  interesting results."
       
       

  "This was the Doppler flow.  Why did you put this in your Ferring symposium?"
       
       

  "I think it  is innovation; it's a new technology that we started to use.  Lots of  physicians were very interested to see the results and the experience       he has  from this kind of examination.  He also showed very nice  data of the difference in patients in the blood flow in the ovarium if  they were treated with either highly purified HMG or if they were  treated with recombinant FSH."
       
       

  "Indeed, he had beautiful pictures and slides with nice colors.  Were there any others special topics within your symposium?"
       
       

  "Then we  introduced at the symposium a nice presentation from Zeleznik where he  showed us the two-cell theory and the importance of LH in the  treatment."
       
       

  "I  think this was a very interesting paper as well.  So indeed, this was a  very interesting symposium you presented.  Thank you very much, and I  must congratulate you on your symposium."
       
       

Ferring Symposium

          "Good morning, it's the third of July of 2001 and we're in  Lausanne at the 17th ESHRE Conference.  Next to me is Professor Hans  Evers who will be the Chairman of ESHRE this afternoon.  Good morning,  Hans."
       
       

  "I want to discuss with you ESHRE and what ESHRE is.  Could you tell us about it, but first the acronym?"
       
       

  "ESHRE  is  the European Society for Human Reproduction and Embryology.  It was  founded eighteen years ago by Professor Robert Edwards and Jean Cohen  from Paris.  It was a reaction to the fact that infertility and  reproductive endocrinology were dispersed over many, many small  organizations in Europe and there was a definite need for one big  organization.  Fortunately, because of their extreme efforts, it took  off very well.  At our first meeting in Bonn, Germany we had 500  participants and it grew very fast till at this moment we have over  4,000 participants at this annual meeting so we are quite glad about  this.  The aim of ESHRE is to stimulate research and also clinical  treatment of infertility and people with problems in the field of  infertility.  ESHRE is also intended to stimulate basic research -  developments into the discovery of follicle maturation, sperm  maturation, implantation, and early pregnancy so it is about all of  reproductive life from fifteen years till forty-five and even beyond."
       
       

  "So it's not a society of clinicians only?"
       
       

  "No,  it's not a society of clinicians only:  it's about half and half; there  are 60% clinicians and 40% basic scientists.  That's also the goal of  not only our annual meeting but also our journals to bring together the  scientists and clinicians in such a way that the clinicians can have the  maximum advantage of interaction with the scientists that new  discoveries reach the clinics rapidly but also in a responsible way  without t much haste - that's the main issue.  I would say we are  inclined, especially in the western world, to introduce new treatments  too fast into the clinic and that's what ESHRE wants to regulate.   Evaluate something very thoroughly before you introduce it but if it is  proven of benefit then don't hesitate too much."
       
       

   "That means that you also need guidelines.  I learned that you are  talking with the European Board and College of Obstetrics and Gynecology  to give some guidelines for further education of fertility doctors."
       
       

  "Yes,  what we would like to start together with the European board is a  credentialing system of clinics for secondary teaching and training in  reproductive medicine which includes visits to those centers that have  asked for accreditation and also at regular intervals checking of their  procedures and their protocols.  This means we need guidelines so ESHRE  is composed of twelve special interest groups who devote themselves to  one of the aspects of reproduction.  One of the main issues of those  special interest groups is to write guidelines and to strive to  consensus on those guidelines, and we publish them as soon as they are  available on the web.  We ask all our members to comment on them, to  suggest changes, and once they have been on the web for a certain time  they are approved and we have printed copies available for all members."
       
       

  "I'm sure you will also have the guidelines online."
       
       

  "Yes,  all of them will be online because, especially in reproductive medicine,  the changes are so very fast that once they are printed they are  out-of-date already.  We try to keep them up-to-date online but we  collect them every two years in booklets to distribute among the  members."
       
       

  "It's a European society, does this mean that the members are all Europeans?"
       
       

  "It  started as a purely European society, the first five years we had  predominantly European members, now more and more members are joining  from outside Europe.  Now one-third of the members are from outside  Europe.  In fact, our fifth biggest member country is the USA so we are  gradually increasing towards the USA and Canada.  We have many, many  members in the Middle East and since our annual meetings have always  been of high quality, I think, they attract many people not only to the  meetings but also to the society. "
       
       

  "Thank you very much, Hans.  I wish you a lot of luck with your presidency next year."
       
       

  "It was a pleasure.  I'm proud that I was elected and I'll be looking forward to do it."
       
       

ESHRE - European Society for Human Reproduction and Embryology

  Het is 3 juli 2001 en we zijn in Lausanne, Zwitserland waar het 17e  ESHRE congres heeft plaatsgevonden. Dat is het congres dat vooral gaat  over infertiliteit en alles wat daar in de verste verte mee te maken  heeft.

In dit congres is gesproken over het belang van websites  voor paren die met onvruchtbaarheid te maken hebben en dat is de reden  dat ik naast me heb Dr. Kees Jansen uit Voorburg (goedemiddag Kees).  Kees, jij was dacht ik de eerste in Nederland die een website had die  geheel gericht was op kunstmatige voortplanting. Je hebt die website nog  steeds. Kun je ons iets vertellen van de ervaringen die je daarmee  hebt.
       
       

 Ja, dat klopt.  Het is vanaf 1996 dat wij een website hebben; overigens niet alleen  voor kunstmatige voortplanting maar ook voor infertiliteit in z’n   algemeenheid, dus het is ook met name ook bedoeld voor alle patinten  maar ook professionals die zich in het gebied van de infertiliteit  interesseren 
       
       

 Je bent begonnen in het Nederlands?
       
       

 Nee, ik ben  begonnen in vier talen om speciale redenen: het is zo dat het  Nederlandse gedeelte van de website voornamelijk is bedoeld voor  patinten die vragen hebben, patinten die informatie willen hebben. Het  zijn natuurlijk altijd jonge patinten die natuurlijk veel meer toegang  hebben tot Internet en computer       De Engelse sectie is vooral bedoeld voor professionals want daarop  kun je bijvoorbeeld onze publicaties met hyperlinks naar de jounals  vonden. Daarop is ook de blastocyste offspring registratie dus dat is  eigenlijk alleen voor professionals
       Dus de Engelse sectie en de Nederlandse sectie zijn niet identiek  aan elkaar: het zijn geen vertalingen. Ze zijn ook voor aparte groepen.  Daarnaast heb je nog de Duitse en de Franse sectie  maar die zijn veel  meer bedoeld om te zeggen wat wij doen en wie zij       zijn.
       
       

 Wat kan de consument vinden op de, laten we ons nu beperken tot de Nederlandse sectie)?
       
       

 De consument ,  de patint en iedereen die op de site wil komen kan vooral veel  informatie krijgen  over onvruchtbaarheid. Maar ook over allerlei  kunstmatige behandelingen zoals In Vitro Fertilisatie, ICSI, Maar ook  dingen  als KID, Intra Uteriene Inseminatie, ovulatie-inductie,       Dus mensen die informatie willen op dat gebied en met name ook wat  dieper gaande informatie die kunnen daar die informatie vinden. 

Het is in feite bedoeld voor verschillende soorten mensen.  Op de pagina’s wordt ook aangegeven wat het niveau is. Dwz level 1 dat  is algemene informatie die in principe voor iedereen begrijpbaar zou  moeten zijn, zo heb ik dat geschreven       Level 2 gaat wat dieper in op infertiliteit voor mensen die wat  meer achtergrondkennis hebben en level 3 is eigenlijk alleen bedoeld  voor professionals dus voor gynaecologen en voor artsen in z’n       algemeenheid.

Mensen die een bepaalde vorm van informatie willen hebben  kunnen die daar ook op       terugvinden. Zo kwamen bijvoorbeeld de laatste jaren steeds weer  mensen op min spreekuur met heel specifieke vragen als: ¨Wat zijn nu de  risico’s van ICSI en dat kostte steeds weer heel veel tijd om dat  genuanceerd  uit te leggen Ik heb het op die manier opgelost door die  informatie, zoals IK het zie op de website te zetten. En ik verwijs naar  de website. Het is interessant dat dat vervolgens een eigen leven is  gaan leiden: want wat ik nu zie is dat een heleboel mensen de website al  gezien hebben en vervolgens komen met extra vragen en dus al een  bepaalde achtergrond       hebben.
       
       

 Ik  denk dat dat inderdaad is waar het met de praktijkwebsite in z’n  algemeenheid naar toe zou moeten gaan, dat  je van te voren al de nodige  informatie kunt krijgen. Mijn vraag is nu: wat is het  verschil tussen  de informatie die jij geeft  en de twee andere gerespecteerde  informatiebronnen, van enerzijds de vereniging Frya en anderzijds de  gynaecologenvereniging, de NVOG. 
       
       

 Dat is een  hele goede vraag: het is zo dat met name de Frya website een uitstekende  website is. Heel goed bruikbaar voor patinten. Ik verwijs er ook naar.  Ik heb dus op mijn pagina ook hyperlinks staan naar informatie op Frya.  Het verschil is wel dat met name op Frya maar ook op de NVOG informatie  ontbreekt naar mijn gevoel: informatie waar ik dagelijks mee te maken  krijg en DIE informatie heb ik op mijn website       staan.

Daarnaast is het natuurlijk ook zo dat er op verschillende  manieren aangekeken kan worden tegen bepaalde problemen in infertiliteit  . Daar maak ik ook geen geheim van zoals ik het op mijn website  zie.  Ik wil niet zeggen dat ik het bij het juiste eind heb, maar wel dat  mensen kunnen weten wat mijn ideen daarover       zijn.

Mijn  website gaan in zeker opzicht dieper in op bepaalde  aspecten  en in bepaalde opzichten sluit het aan op informatie die op  Frya of de NVOG 
       De NVOG met name omdat men nu de NVOG folders krijgen; daar komt  een hyperlink zodat die informatie niet op mijn website hoeft, zodat we  geen dubbele informatie       krijgen. 
       
       

 Verder  is het ook van belang als  je een praktijkwebsite hebt om een zekere  mate van interactiviteit te hebben, bijvoorbeeld om de patinten vragen  te laten stellen. Is dat ook een mogelijkheid die jij hebt?
       
       

 Dat is een  mogelijkheid. Daar maak ik ook gebruik van. Het probleem is: ik heb op  dit moment zo’n honderd bezoeken per dag, Ik heb tussen de 20 en 40  e-mails per dag met vragen. Het grote probleem natuurlijk: als clinicus  practicus is het natuurlijk vrijwel onmogelijk om al die vragen te  beantwoorden met name als het gaat om hele gedetailleerde vragen. Van  die 20-40 E-mails is het toch zo dat ik het overgrote merendeel met een  standaard zal moeten beantwoorden dat ze die toch bij hun eigen  gynaecoloog moeten halen maar er zijn ook regelmatig vragen bij die ook  relevant zijn voor anderen en die beantwoord ik dan uitgebreid maar die  komt dan ook weer op de website bij de rubriek questions & answers
       
       

 Heb je ook een pagina met links naar andere Nederlandstalige websites
       
       

 Nog niet een  aparte pagina. Dat was ik wel van plan om dat te gaan doen. Ik heb wel  op diverse pagina’s verwijzingen naar andere websites , dus hyperlinks  op allerlei pagina’s. Zo is het ook zo dat alle literatuur waarnaar ik  refereer daar zijn hyperlinks naar Pubmed, de Medline database en  hyperlinks naar de journals zoals bijvoorbeeld  the British Medical  Journal (natuurlijk allemaal gratis) . Al die hyperlinks die staan er op  en wat ik ook van plan ben is om in de nabije toekomst een aparte  pagina te maken met een aantal nuttige       website-adressen.
       
       

 Dr Jansen, heel hartelijk dank voor dit interview.

Hans van der Slikke, MD, PhD

Articles

PCOS: What is the Diagnostic Criteria?

PCOS: What is the Diagnostic Criteria?

Presentations at ESHRE

Ferring Symposium

ESHRE - European Society for Human Reproduction and Embryology

IVF Netherlands Web Site(In Dutch)