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In an open uncontrolled trial in 20 men with idiopathic infertility and a low testosterone-to-estrogen ratio, three months of treatment with letrozole resulted in improved sperm motility and morphology, reduced sperm DNA fragmentation, increased testosterone-to-estrogen ratio, and four spontaneous pregnancies

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Patients who have experienced surgical complications such as strictures, gastroesophageal reflux disease (GERD), or peptic/staple-line ulcers require particularly cautious evaluation

122 Another example is Cecropin XJ