***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: OBJECTIVE To assess the efficacy of a clomiphene citrate ( CC ) and tamoxifen citrate ( CC/tamoxifen ) combination therapy in ovulation induction by comparing with a CC alone therapy . DESIGN A r and omized cross-over study with CC alone and CC/tamoxifen combination therapies for 20 normoprolactinemic anovulatory women . R and omly selected 10 of the 20 women ( group A ) underwent a CC alone therapy ( 100 mg CC during cycle days 5 to 9 ) for the initial three consecutive treatment cycles and a CC/tamoxifen combination therapy ( 50 mg CC and 20 mg tamoxifen during cycle days 5 to 9 ) for the subsequent three consecutive treatment cycles . The remaining 10 ( group B ) were treated similarly but with the inverse sequence . Ovulation was documented when a high BBT phase persisted for 11 days or more , when midluteal serum P levels exceeded 7 ng/mL ( 22.3 nmol/L ) , or when pregnancy ensued . RESULTS The rates of ovulatory/treated , pregnant/treated , and pregnant/ovulatory cycles were 42 of 56 ( 75.0 % ) , 3 of 47 ( 6.4 % ) , and 3 of 35 ( 8.6 % ) for CC/tamoxifen , respectively . Those were 25 of 57 ( 43.9 % ) , 1 of 48 ( 2.1 % ) , and 1 of 21 ( 4.8 % ) for CC , respectively . Clomiphene citrate/tamoxifen was more effective in ovulation induction than CC . All the pregnancies were normal and single . None of the treatments was accompanied by any remarkable side effects . CONCLUSION Clomiphene citrate/tamoxifen is a novel treatment modality of ovulation induction with high efficacy To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results OBJECTIVE --To determine whether pituitary suppression before induction of ovulation reduces the rate of spontaneous abortion in women with polycystic ovarian disease and primary recurrent spontaneous abortions . DESIGN --Closed , r and omised , sequential trial . Pairs of women were allocated to each treatment by the toss of a coin . SETTING --Supraregional clinic for women who had had recurrent spontaneous abortions . SUBJECTS -- Forty two women with polycystic ovarian disease and primary recurrent spontaneous abortions . INTERVENTIONS --Ovulation was induced by clomiphene or pituitary suppression with buserelin followed by pure follicle stimulating hormone . MAIN OUTCOME MEASURES --Preference for a particular treatment was noted . A preference occurred when one woman in a pair had a successful pregnancy ( defined as one of over 12 weeks ' gestation ) and one had a spontaneous abortion ; the preference was for the treatment result ing in the successful pregnancy . RESULTS --Spontaneous abortions occurred in 11 of 20 women given clomiphene compared with two of 20 who had pituitary suppression . Eleven preferences were found for buserelin and two for clomiphene . In seven pairs both women had successful pregnancies . One pair was discarded because one of the women did not become pregnant . The ratio of luteinising hormone concentration to follicular diameter was found to be a possible diagnostic indicator of spontaneous abortion . CONCLUSION --Pituitary suppression before induction of ovulation significantly reduces the risk of spontaneous abortion in women with polycystic ovarian disease and primary recurrent spontaneous abortions Antiestrogens are widely used to treat eugonadal anovulation , luteal phase deficiency ( LPD ) and oligospermia . This paper review s the rationale s , endocrine effects , profertility effects and side effects of these treatments . Furthermore , we present our own experience of the use of antiestrogens in this field . We have compared the results of clomiphene citrate ( CC ) to those of tamoxifen ( TAM ) in a r and omized study including 66 infertile women presenting eugonadal anovulation ( n = 26 ) or LPD ( n = 40 ) . Both drugs obtained the same pregnancy rate of 80 % at 9 months in the anovulatory patients . Conversely , CC was superior to TAM in the LPD cases ( pregnancy rates at 6 months of respectively 40 and 11 % ) . The abortion rates were of 11 % on CC versus 36 % on TAM . Both drugs significantly increased the luteal phase length and plasma progesterone level to the same extent . The results of endometrial biopsies suggest that the difference in their effects on female fertility could result from a detrimental effect of TAM on endometrium . The rates of the side effects proved to be almost identical on both drugs . Thus the use of TAM is not justified as a first-step treatment in ovulation disturbances . TAM should be reserved for patients who experience severe visual side effects on CC . We have also tested  TAM in 100 subfertile males . In the 92 oligospermic males , TAM significantly increased the mean sperm count only in the normogonadotropic patients , but as much whether oligospermia was idiopathic or not . Sperm improvement was not significantly related to any hormone criterion except basal serum FSH . The cumulative pregnancy rate was of 41.2 % at 1 year . Whether TAM actually improves male fertility , and is superior to CC in this indication , remains to be confirmed in controlled studies OBJECTIVE To compare the use of an aromatase inhibitor ( letrozole ) with the use of clomiphene citrate ( CC ) . DESIGN Prospect i ve r and omized study . SETTING An infertility clinic in a university hospital . PATIENT(S ) Seventy-four consecutive infertile patients with polycystic ovary syndrome were recruited . Thirty-eight patients were r and omized to the letrozole group ( 99 cycles ) , and the remaining patients were recruited to the CC group ( 95 cycles ) . INTERVENTION(S ) The aromatase inhibitor letrozole ( 2.5 mg/d ) and CC ( 100 mg/d ) were administered orally on days 3 - 7 of menses . MAIN OUTCOME MEASURE(S ) Number of follicles , endometrial thickness , E(2 ) levels on hCG day , and pregnancy rates among both groups . RESULT ( S ) Ovulation occurred in 65.7 % ( 65/99 ) of letrozole cycles and in 74.7 % ( 71/95 ) of CC cycles . The median ( minimum-maximum ) number of follicles sized > 15 mm in diameter on the day of hCG administration were 1 ( 0 - 4 ) and 1 ( 0 - 5 ) in the letrozole and CC groups , respectively . On the day of hCG administration , median serum E(2 ) concentrations in the letrozole and CC groups were statistically significantly different : 189 pg/mL ( 18 - 1,581 pg/mL ) and 386 pg/mL ( 27 - 6,190 pg/mL ) , respectively . The median serum E(2 ) concentrations per follicle sized > 15 mm in diameter on the day of hCG also statistically significantly differed between the letrozole and CC groups : 160 pg/mL ( 18 - 808 pg/mL ) and 281 pg/mL ( 27 - 2,615 pg/mL ) , respectively . The median endometrial thickness on the day of hCG did not significantly differ between the CC and letrozole groups ; it was 8 mm . Pregnancy was achieved in nine cycles ( 9.1 % ) of the letrozole group and in seven cycles ( 7.4 % ) of the CC group , which also was not a statistically significant difference . CONCLUSION ( S ) The aromatase inhibitor letrozole may be an acceptable alternative to CC as an ovulation-induction drug in patients with PCOS Abstract Purpose : To study the effect of CYP17a inhibitor , “ ketoconazole , ” on clomiphene responsiveness in PCOS patients . Methods : Prospect i ve analysis was employed with the setup at Alex and ria IVF/ICSI center . Ninety-seven insulin-resistant PCOS patients undergoing ovulation induction using clomiphene citrate  were r and omly divided , by r and om number table , into two groups . The first group ( n = 49 ) received ketoconazole ( 400 mg daily ) till correction of metabolic syndrome followed by clomiphene ( 100 mg/day ) ; the second group ( n = 48 ) receiving clomiphene without ketoconazole pretreatment . Main outcome measures were incidence of clomiphene resistance , monofollicular response , fasting insulin/glucose ratio , serum testosterone , and pregnancy rates . Results : The ketoconazole group showed significantly ( p < 0.05 ) higher incidence of monofollicular response ( 38 % ) , higher pregnancy rates , and significantly less marked antiestrogenic manifestations than did the control group . They also had significantly lower incidence of clomiphene resistance ( 11.6 % ) , lower serum testosterone levels , less hyperinsulinaemia , than did the control group . Conclusion : Ketoconazole improved clomiphene responsivenss in PCOS patients and attenuated its untoward biological effects Objective To determine the efficacy of pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins in a stepwise approach for inducing ovulation in women with clomiphene-resistant polycystic ovary syndrome ( PCOS ) . Methods Eighty women with clomiphene-resistant anovulatory infertility and PCOS were given subcutaneous pulsatile GnRH ( 15 μg every 90 minutes ) using a portable infusion pump . If no follicular development was seen , clomiphene citrate ( 100 mg/day for 5 days ) was given concurrently with the hormone in the next cycle of treatment . Those who still failed to ovulate regularly were treated with combined pulsatile GnRH with intramuscular gonadotropins ( one ampule per day for 5–7 days ) . Results Sixty-six of 131 ( 50 % ) pulsatile GnRH cycles , 94 of 142 ( 66 % ) pulsatile GnRH with clomiphene cycles , and 48 of 69 ( 70 % ) pulsatile GnRH with gonadotropin cycles were ovulatory . Monofollicular response ( one follicle at least 14 mm on the day of ovulation ) occurred in 80.6 , 83.9 , and 53.6 % of cycles , and multifollicular response occurred in 4.8 , 3.1 , and 21.6 % of cycles in the three groups , respectively . Mild ovarian hyperstimulation occurred in one of the 342 cycles . The cumulative conception rate was 30 % after three cycles , 60 % after six cycles , and 73 % after nine cycles . The miscarriage rate was 22 % ( ten of 45 pregnancies ) , and 35 women ( 78 % ) had live births ( 33 singletons and two sets of twins ) . Conclusion The use of subcutaneous pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins for induction of ovulation in clomiphene-resistant PCOS in a stepwise approach produces a high cumulative conception rate associated with a low rate of multiple pregnancy and ovarian hyperstimulation syndrome Purpose The aim was to test a new protocol of luteal phase administration of clomiphene citrate ( CC ) for ovulation induction in women with polycystic ovary syndrome ( PCOS ) . Methods This was a prospect i ve , r and omized , controlled trial . Two hundred and fifty-two women ( cycles ) with PCOS were utilized to create two groups . Patients in Group 1 ( 126 patients ) received 100 mg of CC daily for 5 days starting on day 5 of menses , and patients in Group 2 ( 126 patients ) received 100 mg of CC daily for 5 days starting the next day after finishing medroxyprogesterone acetate ( MPA ) ( before withdrawal bleeding ) . The main outcome measures were the number of growing and mature follicles , serum E2 ( in pg/mL ) , serum progesterone ( in ng/mL ) levels 
    Output:
    
Other comparisons of interestLimited evidence suggested that compared with a gonadotropin , clomiphene citrate was associated with a reduced chance of a pregnancy , ongoing pregnancy , or live birth , with no clear evidence of a difference in multiple pregnancy rates .
There was limited evidence suggesting that a 10-day regimen of clomiphene citrate improves pregnancy outcomes compared with a 5-day regimen .
AUTHORS ' CONCLUSIONS We found evidence suggesting that clomiphene citrate improves the chance of a clinical pregnancy compared with placebo , but may reduce the chance of live birth or ongoing pregnancy when compared with a gonadotropin .
The evidence was very low quality and no firm conclusions could be drawn , but very limited evidence suggested a benefit from adjunctive dexamethasone or combined oral contraceptives .