Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial
Identifieur interne : 000E42 ( Istex/Corpus ); précédent : 000E41; suivant : 000E43Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial
Auteurs : P. R. Koninckx ; M. Craessaerts ; D. Timmerman ; F. Cornillie ; S. KennedySource :
- Human Reproduction [ 0268-1161 ] ; 2008-09.
Abstract
BACKGROUND Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF- monoclonal antibody, might relieve pain. METHODS A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS Pain severity decreased during the treatment by 30 in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20 of the initial value. CONCLUSIONS Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20. Trials registration number ClinicalTrials.gov: NCT00604864.
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DOI: 10.1093/humrep/den177
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Craessaerts</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Timmerman, D" sort="Timmerman, D" uniqKey="Timmerman D" first="D." last="Timmerman">D. Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Cornillie, F" sort="Cornillie, F" uniqKey="Cornillie F" first="F." last="Cornillie">F. Cornillie</name><affiliation><mods:affiliation>Centocor BV, Medical Affairs Europe, Leiden, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Kennedy, S" sort="Kennedy, S" uniqKey="Kennedy S" first="S." last="Kennedy">S. Kennedy</name><affiliation><mods:affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:81DA3F404A4A595237E53699CABF50459F4D2951</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1093/humrep/den177</idno><idno type="url">https://api.istex.fr/document/81DA3F404A4A595237E53699CABF50459F4D2951/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000E42</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial</title><author><name sortKey="Koninckx, P R" sort="Koninckx, P R" uniqKey="Koninckx P" first="P. R." last="Koninckx">P. R. Koninckx</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</mods:affiliation></affiliation><affiliation><mods:affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: pkoninckx@gmail.com</mods:affiliation></affiliation></author><author><name sortKey="Craessaerts, M" sort="Craessaerts, M" uniqKey="Craessaerts M" first="M." last="Craessaerts">M. Craessaerts</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Timmerman, D" sort="Timmerman, D" uniqKey="Timmerman D" first="D." last="Timmerman">D. Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Cornillie, F" sort="Cornillie, F" uniqKey="Cornillie F" first="F." last="Cornillie">F. Cornillie</name><affiliation><mods:affiliation>Centocor BV, Medical Affairs Europe, Leiden, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Kennedy, S" sort="Kennedy, S" uniqKey="Kennedy S" first="S." last="Kennedy">S. Kennedy</name><affiliation><mods:affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Human Reproduction</title><idno type="ISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-09">2008-09</date><biblScope unit="volume">23</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="2017">2017</biblScope><biblScope unit="page" to="2023">2023</biblScope></imprint><idno type="ISSN">0268-1161</idno></series><idno type="istex">81DA3F404A4A595237E53699CABF50459F4D2951</idno><idno type="DOI">10.1093/humrep/den177</idno><idno type="ArticleID">den177</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0268-1161</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">BACKGROUND Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF- monoclonal antibody, might relieve pain. METHODS A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS Pain severity decreased during the treatment by 30 in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20 of the initial value. CONCLUSIONS Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20. Trials registration number ClinicalTrials.gov: NCT00604864.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>P.R. Koninckx</name><affiliations><json:string>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</json:string><json:string>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</json:string><json:string>E-mail: pkoninckx@gmail.com</json:string></affiliations></json:item><json:item><name>M. Craessaerts</name><affiliations><json:string>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</json:string></affiliations></json:item><json:item><name>D. Timmerman</name><affiliations><json:string>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</json:string></affiliations></json:item><json:item><name>F. Cornillie</name><affiliations><json:string>Centocor BV, Medical Affairs Europe, Leiden, The Netherlands</json:string></affiliations></json:item><json:item><name>S. Kennedy</name><affiliations><json:string>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</json:string></affiliations></json:item></author><articleId><json:string>den177</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>BACKGROUND Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF- monoclonal antibody, might relieve pain. METHODS A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS Pain severity decreased during the treatment by 30 in both the placebo (P > 0.001) and infliximab groups (P > 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20 of the initial value. CONCLUSIONS Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20. 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Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissionsoxfordjournals.org</p></availability><date>2008-06-12</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial</title><author xml:id="author-1"><persName><forename type="first">P.R.</forename><surname>Koninckx</surname></persName><email>pkoninckx@gmail.com</email><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation><affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</affiliation></author><author xml:id="author-2"><persName><forename type="first">M.</forename><surname>Craessaerts</surname></persName><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation></author><author xml:id="author-3"><persName><forename type="first">D.</forename><surname>Timmerman</surname></persName><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation></author><author xml:id="author-4"><persName><forename type="first">F.</forename><surname>Cornillie</surname></persName><affiliation>Centocor BV, Medical Affairs Europe, Leiden, The Netherlands</affiliation></author><author xml:id="author-5"><persName><forename type="first">S.</forename><surname>Kennedy</surname></persName><affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</affiliation></author></analytic><monogr><title level="j">Human Reproduction</title><idno type="pISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-09"></date><biblScope unit="volume">23</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="2017">2017</biblScope><biblScope unit="page" to="2023">2023</biblScope></imprint></monogr><idno type="istex">81DA3F404A4A595237E53699CABF50459F4D2951</idno><idno type="DOI">10.1093/humrep/den177</idno><idno type="ArticleID">den177</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008-06-12</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>BACKGROUND Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF- monoclonal antibody, might relieve pain. METHODS A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS Pain severity decreased during the treatment by 30 in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20 of the initial value. CONCLUSIONS Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20. Trials registration number ClinicalTrials.gov: NCT00604864.</p></abstract></profileDesc><revisionDesc><change when="2008-06-12">Created</change><change when="2008-09">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/81DA3F404A4A595237E53699CABF50459F4D2951/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="publisher-id">humrep</journal-id><journal-id journal-id-type="hwp">humrep</journal-id><journal-title>Human Reproduction</journal-title><issn pub-type="ppub">0268-1161</issn><issn pub-type="epub">1460-2350</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/humrep/den177</article-id><article-id pub-id-type="publisher-id">den177</article-id><article-categories><subj-group subj-group-type="heading"><subject>ORIGINAL ARTICLES</subject><subj-group><subject>Gynaecology</subject></subj-group></subj-group></article-categories><title-group><article-title>Anti-TNF-α treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Koninckx</surname><given-names>P.R.</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref><xref ref-type="corresp" rid="cor1">4</xref></contrib><contrib contrib-type="author"><name><surname>Craessaerts</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Timmerman</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Cornillie</surname><given-names>F.</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Kennedy</surname><given-names>S.</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Obstetrics and Gynaecology</addr-line>, <institution>UZ Gasthuisberg, Katholieke Universiteit Leuven</institution>, <addr-line>B3000 Leuven</addr-line>, <country>Belgium</country></aff><aff id="af2"><label>2</label><addr-line>Nuffield Department of Obstetrics and Gynaecology</addr-line>, <institution>John Radcliffe Hospital, University of Oxford</institution>, <addr-line>Oxford</addr-line>, <country>UK</country></aff><aff id="af3"><label>3</label><institution>Centocor BV, Medical Affairs Europe</institution>, <addr-line>Leiden</addr-line>, <country>The Netherlands</country></aff><author-notes><corresp id="cor1"><label>4</label>Correspondence address. E-mail: <email>pkoninckx@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>9</month><year>2008</year></pub-date><pub-date pub-type="epub"><day>12</day><month>6</month><year>2008</year></pub-date><volume>23</volume><issue>9</issue><fpage>2017</fpage><lpage>2023</lpage><history><date date-type="received"><day>18</day><month>1</month><year>2008</year></date><date date-type="rev-recd"><day>15</day><month>3</month><year>2008</year></date><date date-type="accepted"><day>11</day><month>4</month><year>2008</year></date></history><copyright-statement>© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2008</copyright-year><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/uk/"><p>The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed: the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given: if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative word this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p></license><abstract><sec><title>BACKGROUND</title><p>Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF-α monoclonal antibody, might relieve pain.</p></sec><sec><title>METHODS</title><p>A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy.</p></sec><sec><title>RESULTS</title><p>Pain severity decreased during the treatment by 30% in both the placebo (<italic>P</italic> < 0.001) and infliximab groups (<italic>P</italic> < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20% of the initial value.</p></sec><sec><title>CONCLUSIONS</title><p>Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20%. Trials registration number ClinicalTrials.gov: NCT00604864.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Anti-TNF- treatment for deep endometriosis-associated pain: a randomized placebo-controlled trial</title></titleInfo><name type="personal"><namePart type="given">P.R.</namePart><namePart type="family">Koninckx</namePart><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation><affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</affiliation><affiliation>E-mail: pkoninckx@gmail.com</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Craessaerts</namePart><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Timmerman</namePart><affiliation>Department of Obstetrics and Gynaecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.</namePart><namePart type="family">Cornillie</namePart><affiliation>Centocor BV, Medical Affairs Europe, Leiden, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Kennedy</namePart><affiliation>Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2008-09</dateIssued><dateCreated encoding="w3cdtf">2008-06-12</dateCreated><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>BACKGROUND Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF- monoclonal antibody, might relieve pain. METHODS A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS Pain severity decreased during the treatment by 30 in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20 of the initial value. CONCLUSIONS Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20. Trials registration number ClinicalTrials.gov: NCT00604864.</abstract><relatedItem type="host"><titleInfo><title>Human Reproduction</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0268-1161</identifier><identifier type="eISSN">1460-2350</identifier><identifier type="PublisherID">humrep</identifier><identifier type="PublisherID-hwp">humrep</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>23</number></detail><detail type="issue"><caption>no.</caption><number>9</number></detail><extent unit="pages"><start>2017</start><end>2023</end></extent></part></relatedItem><identifier type="istex">81DA3F404A4A595237E53699CABF50459F4D2951</identifier><identifier type="DOI">10.1093/humrep/den177</identifier><identifier type="ArticleID">den177</identifier><accessCondition type="use and reproduction" contentType="copyright">The Author 2008. 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