***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Enhanced vascularization appears to be important for follicular selection and maturation in both spontaneous and stimulated IVF cycles . Nitric oxide , formed in vivo from L-arginine , may play a key role in follicular maturation and ovulation . METHODS To evaluate the role of L-arginine supplementation in controlled ovarian hyperstimulation , 37 IVF patients were divided into two groups according to ovarian stimulation protocol s : group I , GnRH agonist plus pure (p)FSH plus oral L-arginine ( n = 18 ) ; and group II , GnRH agonist plus pFSH plus placebo ( n = 19 ) . Hormonal , ultrasonographic and Doppler evaluations were performed , and plasma and follicular fluid nitrite/nitrate concentrations were monitored . RESULTS Thirty-two patients completed the study . In group I ( n = 16 ) , plasma L-arginine concentrations increased from ( basal ) 87 + /- 12 micromol to 279 + /- 31 micromol ( P = 0.002 ) on the day of beta-HCG administration . In this group , pFSH treatment was shorter ( P = 0.039 ) than in group II ( n = 16 ) . The number of the follicles > or = 17 mm was lower ( P = 0.038 ) in group I than group II . The " good quality " embryos were fewer in number ( P = 0.034 ) and pregnancy rate , both per patient ( P = 0.024 ) and per embryo transfer ( P = 0.019 ) , was lower in group I. In the L-arginine group , an increased follicular fluid concentration of nitrite/nitrate was observed . On day 8 of the cycle , elevated plasma estradiol levels were associated with decreased blood flow resistances of perifollicular arteries . Follicular fluid concentrations of nitrite/nitrate were inversely correlated with embryo quality ( r = -0.613 ; P = 0.005 ) and perifollicular artery pulsatility index ( r = -0.609 ; P = 0.021 ) . CONCLUSIONS L-Arginine supplementation may be detrimental to embryo quality and pregnancy rate during controlled ovarian hyperstimulation cycles Insulin resistance is one of the most common features of polycystic ovary syndrome ( PCOS ) . Some studies suggest that vitamin D deficiency may have a role in insulin resistance ; thus , the aim of the current study was to determine the effect of vitamin D supplementation on insulin resistance in women with PCOS and a vitamin D deficiency . We hypothesized that vitamin D supplementation would lower the glucose level and insulin resistance in women with PCOS and a vitamin D deficiency . The current study was a r and omized , placebo-controlled , double-blinded trial with 50 women with PCOS and a vitamin D deficiency , 20 to 40 years old , assigned to receive 3 oral treatments consisting of 50,000 IU of vitamin D₃ or a placebo ( 1 every 20 days ) for 2 months ( vitamin D , n = 24 ; placebo , n = 26 ) . The fasting blood glucose , insulin , 25-hydroxyvitamin D , and parathyroid hormone levels , as well as the homeostasis model assessment of insulin resistance and quantitative insulin sensitivity check index were measured at baseline and after treatment . In the vitamin D group , the serum level of 25-hydroxyvitamin D increased ( 6.9 ± 2.8 to 23.4 ± 6.1 ng/mL , P < .0001 ) , and the parathyroid hormone level decreased ( 70.02 ± 43.04 to 50.33 ± 21.99 μ IU/mL , P = .02 ) . There were no significant changes in the placebo group . There was a significant increase in insulin secretion in the vitamin D group ( P = .01 ) , but this was not significant compared with the placebo group . The fasting serum insulin and glucose levels and the insulin sensitivity and homeostasis model assessment of insulin resistance did not change significantly by the end of the study . We were not able to demonstrate the effect of vitamin D supplementation on insulin sensitivity and insulin resistance in women with PCOS and vitamin D deficiency Introduction . We evaluated the effects of a therapy that combines myo-inositol ( MI ) and D-chiro-inositol ( DCI ) in young overweight women affected by polycystic ovary syndrome ( PCOS ) , characterized by oligo- or anovulation and hyper and rogenism , correlated to insulin resistance . Methods . We enrolled 46 patients affected by PCOS and , r and omly , we assigned them to two groups , A and B , treated , respectively , with the association of MI plus DCI , in a 40 : 1 ratio , or with placebo ( folic acid ) for six months . Thus , we analyzed pretreatment and posttreatment FSH , LH , 17-beta-Estradiol , Sex Hormone Binding Globulin , and rostenedione , free testosterone , dehydroepi and rosterone sulphate , HOMA index , and fasting glucose and insulin . Results . We recorded a statistically significant reduction of LH , free testosterone , fasting insulin , and HOMA index only in the group treated with the combined therapy of MI plus DCI ; in the same patients , we observed a statistically significant increase of 17-beta-Estradiol levels . Conclusions . The combined therapy of MI plus DCI is effective in improving endocrine and metabolic parameters in young obese PCOS affected women Purpose : To evaluate the impact of ascorbic acid of different doses as additional support during luteal phase in infertility treatment by means of a prospect i ve , r and omized , placebo-controlled , group comparative , double-blind study . Methods : Voluntary daily oral intake of either ascorbic acid ( 1 , 5 , or 10 g/day ) or Placebo for 14 days after follicle aspiration for IVF-ET procedure . Data was obtained on 620 cases of women , age < 40 years , undergoing first IVF-embryo transfer cycles in two private out-patient infertility clinics . All women were stimulated by the same protocol . The mean age was 31.73 ( ±4.4 SD ) years . Results : No differences in clinical pregnancy rate and implantation rate were noted in statistical logistic regression analysis between the four intake groups . Conclusions : There was no clinical evidence of any beneficial effect , as defined by main outcome measures , of ascorbic acid on IVF-ET . Our data suggest there is no obvious value of high dosed intake of vitamin C during luteal phase in infertility treatment The aim of this r and omized double-blind placebo-controlled pilot study was to evaluate N-acetyl-cysteine ( NAC ) as an adjunctive therapy following unilateral laparoscopic ovarian drilling ( LOD ) for clomiphene citrate-resistant women with polycystic ovary syndrome ( PCOS ) . A total of 60 patients with clomiphene citrate-resistant PCOS who underwent unilateral LOD were assigned r and omly to receive either NAC 1.2 g/d ( group A=30 ) or placebo ( group B=30 ) for 5 days starting at day 3 of the cycle for 12 consecutive cycles . The primary outcome was pregnancy rate ; secondary outcomes were ovulation rates , endometrial thickness and pregnancy outcome . Baseline clinical , endocrine , and sonographic characteristics were similar in the two groups . A significant increase in both ovulation and pregnancy rates was observed in the NAC group , compared with placebo [ 87 % versus 67 % ( RR 1.3 ; 95 % CI 1.2 - 2.7 ) and 77 % versus 57 % ( RR 1.4 ; 95 % CI 1.1 - 2.7 ) , respectively , P<0.01 ] . Moreover , miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group [ 8.7 % versus 23.5 % ( RR 0.4 ; 95 % CI 0.1 - 3.7 ) and 67 % versus 40 % ( RR 1.7 ; 95 % CI 0.3 - 3.5 ) , respectively , P<0.01 ] . In conclusion , NAC is a novel adjuvant therapy after unilateral LOD which might help improve overall reproductive outcome AIM The aim of this study was to evaluate the effect of oral N-acetylcysteine ( NAC ) administration as an adjuvant to clomiphene citrate ( CC ) on induction of ovulation outcomes in patients with polycystic ovary syndrome ( PCOS ) . MATERIAL AND METHODS In this placebo-controlled double-blind r and omized clinical trial , 180 PCOS infertile patients were r and omly divided into two groups for induction of ovulation . Patients in group 1 received CC 100 mg/d plus NAC 1.2 g/d and patients in group 2 received CC plus placebo for 5 days starting at day 3 of the cycle . On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18 - 20-mm diameter in ultrasound evaluation , 10,000 U hCG was injected intramuscularly and timed intercourse was advised 36 h after hCG injection . Serum β-hCG level was measured on the 16th day after hCG injection . RESULTS The number of follicles > 18 mm and the mean endometrial thickness on the day of hCG administration were significantly higher among the CC+NAC group ( P-value = 0.001 ) . The ovulation and pregnancy rates were also significantly higher in the CC+NAC group ( P-value = 0.02 and 0.04 , respectively ) . No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC . CONCLUSION NAC as a safe and well-tolerated adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients . It may also have some beneficial impacts on endometrial thickness There is some controversy over the need for double data entry in clinical trials . In particular , does the number and types of errors identified with this approach justify the extra effort involved ? We report the results of a study carried out to address this question . Our main outcome measure was the frequency and types of errors involved in the entry of data for the CHART ( continuous , hyperfractionated , accelerated radiotherapy ) trials . Data were reentered for a sample of 44 patients by a data manager other than the one making the initial entry . The second entry was then compared with the first entry . The error rate for the two entries combined was 14 per 10,000 data items ( fields ) ( 95 % confidence interval 10 , 19 ) . The error rate for the initial entry alone was 15 per 10,000 fields ( 95 % confidence interval 9.5 , 22 ) , and the vital/important error rate ( defined as any error on a principal outcome measure or a major error on any other endpoint or variable ) was 2.5 per 10,000 fields ( 95 % confidence interval 0.68 , 6.4 ) . On this evidence double data entry is not performed for the CHART trials BackgroudPolycystic Ovary Syndrome ( PCOS ) is a multifactorial pathology that affects 10 % of the women in reproductive age being the main cause of infertility due to menstrual dysfunction . Since 1980 , it is known that PCOS is associated with insulin resistance ( IR ) . The recognition of this association has prompted extensive investigation on the relationship between insulin and gonadal function , and has turned insulin sensitizer agent as the main therapeutic choice . In particular two different polyalcohol myo-inositol and D-chiro-inositol have been shown to improve insulin resistance , hyper and rogenism and to induce ovulation in PCOS women . In particular , while data on myo-inositol and restored ovulation were consistent , data on D-chiro-inositol were not . Recently , a comparative study , proposed a D-chiro-inositol paradox in the ovary of PCOS patients hypothesizing that only myo-inositol has a specific ovarian action . In the present study we aim to further study the role played by D-chiro-inositol at ovarian level . Methods A total of 54 women , aged < 40 years and diagnosed with PCOS were enrolled in this study . Patients with insulin resistance and /or hyperglycaemia were excluded from the study . Patients were r and omly divided into 5 groups ( n=10 - 12 ) : a placebo group , and 4 groups ( A-D ) that received 300 - 600 - 1200 - 2400 mg of DCI daily respectively . All treatments were carried out for 8 weeks before follicle stimulating hormone ( rFSH ) administration . Results Total r-FSH units increased significantly in the two groups that received the higher doses of DCI . The number of immature oocytes was significantly increased in the three groups that received the higher doses of DCI . Concurrently , the number of MII oocytes was significantly lower in the D group compared to placebo group . Noteworthy , the number of grade I embryos was significantly reduced by DCI supplementation . Conclusions Indeed , increasing DCI dosage progressively worsens oocyte quality and ovarian response OBJECTIVE To determine 
    Output:
    
In this review , there was very low- quality evidence to show that taking an antioxidant may provide benefit for subfertile women , but insufficient evidence to draw any conclusions about adverse events .
At this time , there is limited evidence in support of supplemental oral antioxidants for subfertile women