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buy cialis 5mg daily use Suggested mechanisms for poor ovarian response include decreased number of FSH receptors in granulosa cells, defective signal transduction after FSH receptor binding, an inappropriate local vascular network for the distribution of gonadotropins, the presence of autoantibodies against granulosa cells, an excess of vascular growth factor receptor VEGFR- 1, abnormality in IGF- I and IGF- II levels, and diminished circulating gonadotropin surge- attenuating factor GnSAF bioactivity 41 47