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علاج العقم و طفل الأنابيب
مكتبة الإخصاب و علاج العقم
عقم الرجال
عقم النساء
تفسير أسباب العقم
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ركن أختيار المولود/ ذكر أم أنثى
هل يمكن أختيار نوع أو جنس الجنين
كيف يتم أختيار الجنس أو النوع
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أقسام كلية الطب
التشريح
قسم التخدير
الكيمياء الحيوية
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أمراض باطنية
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علم الأدوية
علم الأمراض
علم وظائف الأعضاء
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... أنقر هنا لزيارة منتدى تأخر الإنجاب و علاج العقم للدكتورة زينب ابوطالب    تنبيه...  حذرت إدارة الأغذية والعقاقير الأمريكية من استخدام أو شراء كريم تليين الحلمة للأمهات المرضعات لأنه يحتوي على مكونات ضارة بالجهاز التنفسي للأطفال. فمن الممكن أن يسبب الكرب وضيق التنفس, والتقيؤ والإسهال لدى الأطفال ...

 

العيادات النهارية ـ مستشفى الملك خالد الجامعي

مواعيد العيادات النهارية للدكتورة زينب أبوطالب في جامعة الملك سعود ـ عيادات علاج العقم على الهاتف 4672150-01 أو  4679233-01 وفي  حال عدم التمكن من الحصول على موعد يرجى الكتابة إلى الفاكس التالي 2253116 يحدد فيه أسباب عدم إعطائك موعد حتى نقدم النصيحة لك في ذلك.

 

العيادات المسائية للدكتوره زينب ابوطالب

مواعيد العيادات المسائية للدكتورة زينب أبوطالب ـ عيادات علاج العقم و طفل الأنابيب على الهاتف 4622224-01 في  حال عدم التمكن من الحصول على موعد يرجى الكتابة إلى الفاكس التالي 2253116  يحدد فيه أسباب عدم إعطائك موعد حتى يمكن تقديم النصيحة لك في ذلك.  

 

    الحديث عن تأخر الإنجاب؟
 
وعلاج العقم وطفل الأنابيب
 وكيف يزيد الزوجان من مستوى الإخصاب, وكيف يكون الإخصاب ناجحاً, وكيف يعزز الرجل والمرأة من خصوبتهم, وهل هناك صعوبة في أن تحمل المرأة؟ عموماً إذا كنت وزوجتك تحاولان الإنجاب منذ البداية تكوين أسرة بدون نجاح, فلا تفقد الأمل وأحرص على بذل الأسباب. أنقر هنا للمزيد

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 أغلق الصوت في برنامج الفلاش أعلى الصفحة قبل بدء هذا البرنامج

 مدينة سلطان بن عبد العزيز للخدمات الإنسانية نموذج متكامل للعمل الخيري

تعتبر مدينة سلطان بن عبد العزيز للخدمات الإنسانية  إحدى مشاريع مؤسسة سلطان بن عبدالعزيز آل سعود الخيرية التي تتألف مشاريعها من أربعة أقسام رئيسية وهي الخدمات الطبية، العلمية، التقنية، والتربية الاجتماعية.  وهذا المشروع الطبي العملاق يعتبر من أكبر المشاريع الطبية التأهيلية على مستوى العالم، حيث تبلغ مساحة المدينة 1.200.000 متر مربع وتقع في منطقة بنبان شمال مدينة الرياض على طريق الرياض القصيم السريع

وتهتم المدينة بتقديم الرعاية الطبية التأهيلية للمرضى من ذوي الاحتياجات الخاصة من مسنين وبالغين وأطفال 

§       الأولى من نوعها:

تحرص مدينة سلطان بن عبد العزيز للخدمات الإنسانية  على توفير جو من الرعاية الصحية، مع العناية بصفة خاصة بالخدمات التأهيلية الرائدة.

وتعد مدينة سلطان بن عبد العزيز للخدمات الإنسانية  الأولى من نوعها في بلدان الشرق الأوسط في مجالين طبيين متكاملين، وهما العلاج الطبيعي والتأهيلي. وتقدم المدينة برامج طبية متخصصة لمرضاها من ذوي الإحتياجات الخاصة وغيرهم على اختلاف أعمارهم وحالاتهم ليعودوا بعد ذلك لذويهم ومجتمعهم وهم –بإذن الله -، في أفضل وضع طبي وتأهيلي ممكن .

ولدى المدينة برنامج يعتمد على منهج متعارف عليه عالمياً، يمكن من خلاله مراقبة تطور حالة المريض.

إن وجود مدينة سلطان بن عبد العزيز للخدمات الإنسانية في المنطقة سيؤدي –بإذن الله- إلى توفير الرعاية الصحية والتأهيلية لكل من هم بحاجة أليها، وذلك ضمن التطلعات إلى بناء مجتمع أفضل.

§ مراكـز متفوقة :-

تقدم مدينة سلطان بن عبد العزيز للخدمات الإنسانية  الرعاية لمراجعيها ومرضاها المنومين، والعناية بإعادة التأهيل للحالات المتوسطة والحادة فيها، بأيدي مجموعة من الاستشاريين الأخصائيين في العلاج، وخبراء الجراحة، عن طريق المراكـز التالية:

1-  مركز إعادة التأهيل الطبي:

وهو مستشفى لإعادة التأهيل من 240 سريراً، يقدم خدمات تأهيلية شاملة للأطفال والبالغين لعلاج الحالات التالية:

- التهاب المفاصل.                            – بتر الأعضاء.

- إصابات الحبل الشوكي.                   – الإصابات الدماغية.

- السكتة الدماغية.                           – أمراض القلب.

- الجهاز العصبي.                             – التجبير وتقويم العظام.

- طب الأطفال.                              – الآلام المزمنة.

- أمراض الجهاز التنفسي.                   – صعوبة النطق والتخاطب.

- عدم التكيّف العام.                        – أمراض الشيخوخة.

 2-  مركز النقاهة ورعاية المسنين:

يقدم المركـز خدمات إعادة التأهيل والمعالجة الدوائية، للتركيز على إدراك البالغين والكهول من خلال فريق تنظيم داخلي لديه المعرفة والتفهم لهذا التأهيل الاستثنائي.

3- مركز العيادات الإستشارية الخارجية:

يقدم المركـز كافة الاحتياجات العلاجية والجراحية للمرضى من خلال عيادات استشارية متكاملة لكافة التخصصات الطبية بما في ذلك خدمات الجراحة وطب الأسنان.

4- مركز تنمية الطفل:

يقدم المركـز برامج علاجية للأطفال دون سن العاشرة الذين يعانون من إعاقات في النم

§ التدريب والتعليم:

ويعتبر برنامج تأهيل وتدريب الموظفين السعوديين للعمل في مدينة سلطان بن عبدالعزيز للخدمات الإنسانية أحد أهداف هذه الإدارة الذي يهدف إلى تأهيل وتدريب العاملين السعوديين نحو عطاء أفضل واداء متميز كل وفق تخصصه .

§ مبنى الإدارة:

 ويتكون من أربعة طوابق ويضم مكاتب الجهاز  الإداري ومرافق التدريب ، ومكتبة طبية.

§ قاعة المؤتمرات :

وتتسع ل (400) شخص وجهزت القاعة بنظام سمعي  وبصري وأجهزة اتصالات فضائية. 


حقل جديد للإنسان الآلي يتيح مجالاً واسعاً لنشاط  رواد علم أمراض النساء
للقيام بالحد الأدنى من العمليات الإجتياحية
أنقر على العرض بعد قرآة النص, لمشاهدة العمليات الجراحية المتلفزة
 


The Next Frontier in Minimally Invasive Gynecologic Surgery

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view the presentation | read the transcript

Arnold Advincula, MD
Associate Professor
Director of Minimally Invasive Surgery Program & Fellowship
Department of Obstetrics & Gynecology
University of Michigan
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ـRobotics: The Next Frontier in Minimally Invasive Gynecologic Surgery

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Charles Miller, MD
Clinical Associate Professor, Department of Ob/Gyn
University of Illinois at Chicago
Directory of Minimally Invasive Gynecologic Surgery
Lutheran General Hospital
Park Ridge, Illinois

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Robotics in Gynecology

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Javier Magrina, MD
Professor & Chair, Department of Ob/Gyn
Barbara Woodward Lips Professor
Mayo Clinic
Scottsdale, Arizona

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Laparoscopic Sacral Colpopexy Using the daVinci System

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Patrick Culligan, MD
Directory, Division of Urogynecology & Reconstructive Pelvic Surgery
Atlantic Health System
Morristown, New Jersey

 
 

حاز الموقع على جائزة أفضل ثالث موقع لأعضاء هيئة التدريس

 و الأستشاريين في كلية الطب ـ بجامعة الملك سعود

 Shoulder Dystocia has the potential for causing significant, lifelong injury to the newborns.

Shoulder dystocia is an obstetrical complication that occurs in thousands of deliveries in the US each year. It has the potential for causing significant, lifelong injury to the newborns involved in such deliveries. Despite the hundreds of published studies on shoulder dystocia many important questions remain:

  1. Is shoulder dystocia predictable?

  2. Can it be prevented?

  3. When it does occur,
    can anything be done to decrease the risk of brachial plexus injury?

  4. If there is an injury,
    was it caused by mismanagement on the part of the physician while attempting to resolve the shoulder dystocia
    or was it an inevitable consequence of the dystocia

  5.    أنقر هنا للمزيد من المعلومات عن هذا الموضوع في موقع

Fact and evidence about Shoulder  Dystocia

All these questions can be answered by looking to the links in this section  

ولادة الجنين بالكتفين

 

 
 
 

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Questions & Answers about
Intrauterine Insemination (IUI)
 

Q: What is an IUI and how is it done?

A: An IUI -- intrauterine insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long — it usually only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable. A typical "Tomcat" catheter is shown below.

Q: Where is the sperm collected? How long before the IUI?

A: Usually the sample is collected through ejaculation into a sterile collection cup, but it is also possible to obtain collection condoms for

 this purpose (through the doctor's office -- Milex is one company that makes them). Most clinics want the semen to be delivered within a half hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home. If not, one has to make do with a room at the clinic, a bathroom, or any private setting.

There is a delay between when the semen sample is dropped off for washing and when it is inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic's scheduling. Most will perform the IUI as soon after washing is completed as possible

Q: What is an IUI and how is it done?

A: An IUI -- intrauterine insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long — it usually only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable. A typical "Tomcat" catheter is shown below.

Q: Where is the sperm collected? How long before the IUI?

A: Usually the sample is collected through ejaculation into a sterile collection cup, but it is also possible to obtain collection condoms for this purpose (through the doctor's office -- Milex is one company that makes them). Most clinics want the semen to be delivered within a half hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home. If not, one has to make do with a room at the clinic, a bathroom, or any private setting.

There is a delay between when the semen sample is dropped off for washing and when it is inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic's scheduling. Most will perform the IUI as soon after washing is completed as possible.

Q: When is the best timing for an IUI?

A: Ideally an IUI should be performed within 6 hours either side of ovulation — for male factor infertility some doctors believe after ovulation is better, otherwise chances of success are higher with insemination before ovulation with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG, though some do it at 24 hours, and some clinics are reporting better results when doing the IUI at 40-42 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG. Some reports show no increase in success rates with two IUIs, but others suggest it may increase success as much as 6 percent.

Some doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also pretty common since ovulation may be a bit earlier. When two inseminations are planned, they are usually timed between 12 and 48 hours after the surge is detected.

The egg is only viable for a maximum of 24 hours after it is released.

Q: What is the success rate for IUI?

A: Searching through about a dozen medical journal articles and a number of web sites resulted in a rather wide range of statistics. Basically the odds of success are reported to be just under 6 percent and as high as 26 percent per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26 percent success. Another influencing factor is sperm count. Higher sperm counts increase the odds of success; however, there was little difference between success with good-average counts and those with high counts. The overall success rate seems to be between 15-20 percent per cycle, judging from the articles which will be abstracted below. The rate of multiple gestation pregnancies is 23-30 percent.

Q: What does an IUI feel like?

A: Most women consider IUI to be fairly painless -- along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter usually doesn't feel like much since the cervix is already slightly open for ovulation -- a poorly timed IUI might cause more discomfort at the cervix.

Q: How long does washed sperm live?

A: Current research indicates that washed sperm can live 24-72 hours; however, it does lose potency after 24 hours. Another issue with IUI is that the sperm can keep on swimming beyond the fallopian tube, so the ideal window is really within 6-12 hours of the egg being released, with a larger margin before ovulation than after since the egg's viability is shorter. Sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common, so combining IUI with intercourse may provide better coverage.

Q: Do I have to lay down after an IUI?

A: You don't have to lay down because the cervix doesn't remain open, but most doctors let patients lay down on the table for 15-30 minutes after the procedure.

Q: Do I need to take it easy after an IUI?

A: Most people don't need to, but if you had cramping or don't feel well afterward it makes sense to take it easy for awhile. Some people reduce their aerobic activity and heavy lifting during the luteal phase in hopes it will increase the chance of implantation. It is more important to take it easy for a bit after IVF, as that is a more invasive process.

Q: How long before an IUI should the male abstain from intercourse/ejaculating and store up sperm?

A: This depends on your individual situation, but it usually should not be more than than 72 hours since his last ejaculation in order to ensure the best motility and morphology. Where low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI. With no sperm count issues, it makes sense to wait at least 24 hours. Some suggest trying for about 36 hours to cover the most territory with the highest counts — a common suggestion is to have intercourse around the time of hCG injection.

Q: How soon after an IUI can I have intercourse?

A: Usually you can have intercourse anytime after an IUI . . . in fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. Your doctor may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI or if a tenaculum is used.

Q: Can the sperm fall out?

A: Once the sperm is injected into the uterus, it does not fall out. There can, however, be increased wetness after the procedure because of the catheter loosening mucus in the cervix and allowing it to flow out. Some doctors will insert a cup around the cervix to prevent leakage, but most do not.

Q: How come I feel wetter after the IUI — like the sperm is falling out?

A: The catheter loosens cervical mucus and lets it come out more easily. It is common to see more fertile mucus after an IUI for this reason, as well as the fact that well-timed IUI should be close to ovulation.

Q: How many follicles give my best chance of getting pregnant?

A: According to different studies, either 3-4 follicles gives one the best chance of getting pregnant, while more follicles beyond that simply increases the risk of multiples. The U.S. study said 4 follicles, while other countries have data stating 3. The U.S. has a higher rate of multiple births, so 3 may be more likely to be the correct answer.

Q: Does IUI make sense when there isn't a sperm count problem?

A: IUI can help on Clomid cycles where cervical mucus is a problem, and IUI increases the chance of success on injectable cycles no matter what the sperm count. It does make sense to try IUI if you can and haven't had success with intercourse. It is important to note that with intercourse, only the best and strongest sperm make it through the cervical mucus and up into the uterus and fallopian tubes. With IUI, more sperm will be available for fertilization.

Q: How high a sperm count is needed for IUI?

A: A count above one million washed appears necessary for success, with a significant reduction in pregnancy rates when the inseminated is count is lower than 5-10 million (in other words, in most cases one should consider 5 million a lower limit for success, 10 million for cost-effective). Higher success rates are with washed counts over 20-30 million, while increasing counts over 50 million did not appear to offer advantage. Advanced Fertility has a chart of success rates for one month of various treatments.

Q: How many IUIs should I try before moving on to IVF?

A: It depends on what you can afford and what meds you are doing. One might do 3-4 IUIs on Clomid before moving on to injectables, then do 3-4 cycles on injectables. If one doesn't have success after four good ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.

Q: Can IUI be done at home?

A: An IUI shouldn't be done at home without medical supervision because the sperm needs to be washed to prevent infection -- i.e., separated from the semen. A vaginal insemination can be done at home, but is no more successful than intercourse. Some doctors are willing to instruct on doing ICI (intracervical insemination) at home, but it should not be attempted without being taught proper technique. Getting semen or air into the uterus could be quite dangerous -- perhaps life-threatening. One woman wrote in to say there is a midwife practice in Berkeley, CA, that will do inseminations at the patient's home, so it may be worth asking about.

Q: Is bleeding common after an IUI?

A: It doesn't usually happen, but it isn't uncommon. It is most common to have some bleeding if the doctor had trouble reaching the cervix. Some women also have light bleeding with ovulation.

Q: How long after IUI should implantation occur?

A: Implantation generally takes place 6-12 days after ovulation — so 6-12 days after a well-timed IUI.

Q: How much does IUI cost?

A; This is definitely something to consult your doctor or clinic about as the price varies considerably. Ask for a rate sheet, if available, and also ask what your cycle is likely to entail. The IUI procedure and sperm washing average $200-300, but the cost of medications, ultrasounds and bloodwork can make a considerable difference. Someone doing a natural IUI cycle may spend only $200, while someone on injectable medications with monitoring may spend $5,000-6,000.

Q: What kind of monitoring is usually done for an IUI cycle?

A; This depends mostly on how the female is being treated. A natural cycle is often timed to over the counter ovulation prediction kits, which cost $15-60 for 5-9 tests. The use of clomiphene citrate can increase the monitoring, but many doctors don't do ultrasounds or settle for one u/s around cycle day 12. Gonadotropins increase both medication costs and the necessity of ultrasounds and bloodwork.

Q: At what size are follicles considered mature?

A: Many doctors monitor follicle development during IUI cycles. Most trigger when the dominant follicle is within a certain size range. While there is always some difference in doctor preference, the norms are unmedicated 20-24mm, clomiphene citrate 20-24mm, FSH-only meds 17 or 18mm minimum, and FSH+LH would be 16 or 17mm minimum. It is possible for slightly smaller follicles, 14-15mm, to contain a viable egg. Also, follicles continue to grow until they release, usually at a rate of about 1-2 mm per day. A woman may ovulate more than one follicle in a cycle, but the releases will occur within 24 hours. When hCG is not used, only follicles close in size are likely to release. The use of hCG induces ovulation in about 95 percent of women, and will get most mature follicles to rupture.

Q: What should estradiol (E2) level be at time of hCG trigger?

A: The E2 level should be 200-600pg/ml per 18mm follicle. Some doctors are content with a minimum level of 150, but higher tends to be better.

Q: What are the risks involved in IUI?

Q: The main risks are some discomfort such as cramping, minor injury to the cervix that leads to bleeding or spotting, or introduction of infection (including sexually transmitted disease from the sperm itself — it helps to be sure of the known donor's health, or use carefully monitored frozen specimens). There are also risks of hyperstimulation associated with the use of ovulation induction medications such as clomiphene citrate (low risk) and gonadotropin therapy (higher risk). Proper technique and adequate monitoring reduce risks.

Q: Can I take pain medications before or after the procedure?

A: Most women don't need medication for pain associated with IUI. If there is cramping, it is best to avoid medications such as ibuprofen and naproxen, but Tylenol is considered safe (but maybe not that helpful for cramps).

Q: What does "sperm washing" mean?

A: It is sometimes also called sperm preparation or spinning. It is a laboratory technique for separating sperm from semen, and separating motile sperm from non-motile sperm, for use in assisted reproduction (IUI, IVF).

The washing technique for near normal specimens is mixing the ejaculate after liquefaction with the appropriate washing medium followed by centrifugation. (A centrifuge is a machine that separates materials with different densities by spinning them at high speed.) The supernatant is discarded and the sediment (sperm rich fraction) is re-suspended in more washing medium. This process is repeated 2-3 times maximum. In the final wash, the sediment is re-suspended in 0.5 cc of medium, loaded into a syringe and deposited in the uterus.

The "Sperm Rise" or "Swim-up" technique is one in which two to five cc of medium are carefully layered on top of 0.2-0.5 cc of semen. Motile sperm cells "swim-up" into the culture medium. After some time (30-90 minutes) the medium (containing motile sperm cells) is carefully harvested and centrifuged. If necessary, fresh medium is layered on top of the seminal fluid again to harvest more sperm cells.

The discontinuous gradient centrifugation technique utilizes a dense liquid phase to separate sperm cells from seminal fluid and debris. There are different compounds commercially available that may be used. Semen is deposited on top of this fluid and subjected to centrifugation. Motile sperm cells migrate to the bottom of the tube, which are used for IUI after further washing.

Q: How soon after an IUI can I go swimming?

A: Since the vagina doesn't open unless something pushes it, it is OK to swim shortly after your IUI . . . but because of how much one has invested in getting pregnant, it probably makes sense to wait 48 hours after your IUIs to go swimming.

Q: Can IUI work after tubal ligation (having "tubes tied")?

A: No. A tubal ligation is effective birth control because it prevents the sperm and egg from meeting. The process that leads to pregnancy is having an egg released from a follicle in the ovary and then beginning the journey to the uterus through the fallopian tube. Sperm will travel from the vagina, through the cervix, through the uterus, into the tube where fertilization occurs. IUI bypasses the need for the sperm to travel through the cervix, but that's it. It doesn't get the egg to the other side of the obstruction, so fertilization won't take place. The only way to get pregnant after tubal ligation is by having reversal surgery or an assisted reproduction technology that includes egg retrieval, such as in vitro fertilization (IVF).

Q: Can IUI be used for gender selection?

A: Yes, sperm can be washed or spun to increase the odds of having a male or female offspring.The techniques aren't 100 percent effective, but perhaps as high as almost 90 percent. There is usually greater success selecting boys.

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Preimplantation Genetic Diagnosis: Evaluation for Single Gene Disorders (PGD)

أنقر أسفل لمعرفة المزيد

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     قائمة بالعديد من الجامعات والمكتبات

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    جميع المعلومات للدراسة فى كندا

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    المكتبات

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