***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: The relative effectiveness of in-vitro fertilization ( IVF ) , gamete intra-Fallopian transfer ( GIFT ) and intrauterine insemination ( IUI ) combined with superovulation in the treatment of infertility were compared in 151 couples undergoing a single cycle of treatment . Treatment was selected as appropriate ( IVF for tubal disease , GIFT or IUI/superovulation for nontubal infertility ) but possible bias due to non-r and omization was overcome by all couples having had favourable fertilization in a previous cycle of IVF . Furthermore , in a preliminary study of initial IVF treatment in 265 couples from whom the study patients were drawn , implantation and pregnancy rates in the diagnostic groups were similar . In the definitive study comparing IVF , GIFT and IUI/superovulation , the pregnancy rate observed with GIFT was highest ( 40 % ) but this was not significantly higher than with IVF ( 28 % ) or IUI/superovulation ( 20 % ) . However , the implantation rate per egg transferred by GIFT ( 21 % ) was significantly higher than the implantation rate per embryo transferred by IVF ( 11 % ) . Although the pregnancy rates with GIFT were not statistically greater than with IVF , a significant advantage is likely to be observed in larger groups in view of the better implantation rate . The lower pregnancy rates with IUI superovulation are to be expected because of limited ovarian stimulation , they are nevertheless of comparative interest OBJECTIVE To assess the impact of prior unilateral or bilateral endometrioma cystectomy  on controlled ovarian hyperstimulation ( COH ) and intracytoplasmic sperm injection ( ICSI ) outcome . DESIGN Retrospective case-control study . SETTING Department of Obstetrics and Gynecology , School of Medicine , Hacettepe University , Ankara , Turkey . PATIENT(S ) Fifty-seven consecutive infertile patients were enrolled who had previously undergone unilateral ( n = 34 ) or bilateral ( n = 23 ) laparoscopic cystectomy for endometriomas more than 3 cm in diameter and underwent ICSI .  The control group consisted of 99 patients with tubal factor infertility . INTERVENTION(S ) Controlled ovarian hyperstimulation and ICSI . MAIN OUTCOME MEASURE(S ) Cycle cancellation rate , number of oocytes , fertilization rate , embryo quality , clinical pregnancy rate ( PR ) , and implantation rate . RESULT ( S ) The mean number of oocytes , metaphase II oocytes , and two-pronucleated oocytes were significantly lower in the bilateral cystectomy group compared to the unilateral cystectomy and control groups . However , all other parameters , including fertilization rate , the mean number of embryos transferred , the mean number of grade 1 embryos transferred , the clinical PR per embryo transfer , and implantation rate , were comparable among the three groups . Within the unilateral cystectomy group , the mean number of oocyte retrieved from the operated site was significantly less than in the contralateral nonoperated site . CONCLUSION ( S ) Laparoscopic endometrioma cystectomy does reduce the ovarian reserve . However , diminished ovarian reserve does not translate into impaired pregnancy outcome BACKGROUND To eluci date possible differences between unexplained and minimal peritoneal endometriosis-associated infertility , we studied their outcome in natural cycle IVF ( NIVF ) . METHODS A prospect i ve cohort study was carried out on unexplained ( 33 couples ) , minimal peritoneal endometriosis-associated ( 30 couples ) and tubal factor ( 24 couples ) infertility in 223 NIVF cycles , using human chorionic gonadotrophin ( HCG ) for ovulation induction . RESULTS During the first NIVF attempt , follicular and luteal phase oestradiol , FSH , LH and progesterone concentrations , as well as endometrial thickness and follicular diameter were similar among the three groups . Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility . The fertilization rate , clinical pregnancy rate per initiated cycle , per successful oocyte retrieval and per embryo transfer , in minimal endometriosis ( 80.0 , 10.4 , 16.0 and 23.5 % respectively ) were similar to that in tubal factor infertility patients ( 68.6 , 5.8 , 11.4 and 16.0 % ) but significantly higher ( P < 0.05 ) than that of the unexplained infertility group ( 62.2 , 2.6 , 5.4 and 8.7 % ) . CONCLUSIONS The significant reduction in follicular periovulatory growth , fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality , intrinsic embryo quality factors or by impaired implantation . From a clinical point of view , NIVF is less suited to unexplained infertility treatment , but might represent an interesting treatment option for minimal peritoneal endometriosis-associated infertility In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility , we conducted a r and omized clinical trial . Eligible patients were women aged < /=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis ( stage I or II of the revised American Fertility Society classification ) and otherwise unexplained infertility for > /=2 years . Eligible women were r and omly assigned to resection or ablation of visible endometriosis ( 54 patients ) or diagnostic laparoscopy only ( 47 patients ) . After laparoscopy women tried to conceive spontaneously for 1 year ( follow-up period ) . A total of five women withdrew from the study : three for personal reasons , and two were lost to follow-up . Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period , 12 ( 24 % ) in the resection/ablation group and 13 ( 29 % ) in the no treatment group conceived ; the difference was not significant . Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one . Thus the 1 year birth rate was 10 out of 51 women ( 19.6 % ) in the resection/ablation group and 10 out of 45 women ( 22.2 % ) in the no-treatment group . In conclusion , the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates OBJECTIVE To investigate the outcomes of intracytoplasmic sperm injection ( ICSI ) cycles after controlled ovarian hyperstimulation ( COH ) with GnRH antagonist or GnRH agonist ( GnRH-a ) in mild-to-moderate endometriosis and endometrioma . DESIGN Prospect i ve r and omize trial . SETTING A private IVF center . PATIENT(S ) A total of 246 ICSI cycles in 246 patients were divided into three groups : women with mild-to-moderate endometriosis ( n = 98 ) ; women who had ovarian surgery for endometrioma ( n = 81 ) ; women with endometrioma and no history of previous surgery ( n = 67 ) . INTERVENTION(S ) Patients in each group were r and omized to COH with either triptrolein or cetrorelix . MAIN OUTCOME MEASURE(S ) Clinical parameters , characteristics of COH , and ICSI results were analyzed . RESULT ( S ) Outcomes of COH with both GnRH antagonist and GnRH-a were similar in patients with mild-to-moderate endometriosis .  Implantation rates were 15.9 % vs. 22.6 % and clinical pregnancy rates were 27.5 % vs. 39 % with GnRH antagonist and GnRH-a protocol s , respectively , in patients who had ovarian surgery for endometrioma .  Implantation rates were 12.5 % vs. 14.8 % and clinical pregnancy rates were 20.5 % vs. 24.2 % with GnRH antagonist and GnRH-a protocol s , respectively , in patients with endometrioma and no history of ovarian surgery . CONCLUSION ( S ) Considering the implantation and clinical pregnancy rates , COH with both GnRH antagonist and GnRH-a protocol s may be equally effective in patients with mild-to-moderate endometriosis and endometrioma who did and did not undergo ovarian surgery OBJECTIVE To evaluate the efficacy of reoperation for stage III or IV endometriosis-related infertility versus IVF-ET . DESIGN Retrospective analysis . SETTING In vitro fertilization-embryo transfer unit and tertiary infertility clinic . PATIENTS Twenty-three couples with stage III or IV endometriosis-related infertility undergoing IVF-ET and 18 women undergoing reoperation for stage III or IV disease , both groups undergoing treatment after failed initial surgery to restore fertility . RESULTS The cumulative pregnancy rate ( CPR ) after reoperation for stage III or IV endometriosis-related infertility after 3 , 7 , and 9 months was 5.9 percent , 18.1 percent and 24.4 percent , respectively . The cumulative PR after one and two cycles of IVF-ET with stage III or IV endometriosis was 33.3 percent and 69.6 percent , respectively . The cumulative PR after one cycle of IVF-ET was higher than with reoperation 33.3 percent versus 24.4 percent . After two cycles the cumulative PR was significantly higher than reoperation 69.6 percent versus 24.4 percent . The mean number of oocytes retrieved was 8.5 + /- 4.6 , the mean number of embryos was 4.8 + /- 2.9 , and the fertilization rate was 64 percent + /- 21.8 percent . The PR per cycle , per oocyte retrieval and per ET was 38 percent , 42 percent , and 44 percent , respectively , with the implantation rate being 16 percent . The live birth rate per oocyte retrieval and per ET was 29.7 percent and 34.4 percent , respectively . No statistically significant difference could be demonstrated with regard to the fertilization , implantation , nor pregnancy or live birth rates , as compared with IVF-ET outcome with tubal infertility . CONCLUSION If initial surgery fails to restore fertility in patients with moderate ( stage III ) or severe ( stage IV ) endometriosis-related infertility , IVF-ET is an effective alternative ; reoperation for asymptomatic patients offers little added benefit The literature suggests that the results of in-vitro fertilization ( IVF ) for patients with endometriosis depend on the stage of the disease , and that patients with severe endometriosis have a higher failure rate . Miscarriage is said to be more prevalent in women treated for endometriosis . In the study reported here , 140 patients with endometriosis underwent 182 cycles of IVF using gonadotrophin-releasing hormone analogues ( GnRHa ) . Patients with endometriosis only were allocated to one group ( group 4 ) . The results were compared with those of three other groups of patients undergoing the same treatment within the same period . Group 1 consisted of couples with male factor only ( 45 cycles ) , group 2 , couples with unexplained infertility ( 196 cycles ) and group 3 , couples with a tubal factor only ( 1139 cycles ) . The mean age of the patients , mean number of human menopausal gonadotrophin ( HMG ) ampoules administered , oestradiol concentration on the day of human chorionic gonadotrophin administration , number of days of HMG , mean number of oocytes retrieved and retrieval rate were not significantly different . The fertilization rate was significantly lower in group 1 ; no difference was observed in the other three groups . The mean number of normally fertilized embryos was not significantly different . The number of transferred embryos in each cycle and the implantation rates were similar in the four groups . The overall pregnancy rate per transfer was 39 % in group 1 , 48 % in group 2 , 45 % in group 3 and 40 % in group 4 . ( ABSTRACT TRUNCATED AT 250 WORDS Cytokines , and specifically interleukin 6 ( IL-6 ) and interleukin 8 ( IL-8 ) , have been associated with the pathogenesis of endometriosis . We studied serum concentrations of IL-6 and IL-8 in patients with deep infiltrating endometriosis ( DIE ) or ovarian endometriomas ( OE ) , but no other forms of associated endometriosis disease type . We carried out a case-control study including 19 patients with OE alone ( OE group ) , 14 patients with DIE alone ( DIE group ) and 24 healthy patients without endometriosis ( C group ) .  Serum concentrations of IL-6 and IL-8 were measured in the three groups of patients . Serum levels of both IL-6 and IL-8 were significantly higher in the OE group . A high positive correlation was found between serum IL-6 and IL-8 levels in the OE group but not in the DIE and C groups . Serum IL-8 alone achieved the highest predictive value of the presence of OE ( adjust 
    Output:
    
: Women with and without endometriosis have comparable ART outcomes in terms of live births , whereas those with severe endometriosis have inferior outcomes .
There is insufficient evidence to recommend surgery routinely before undergoing ART