***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 compare basal body temperature ( BBT ) graphs and urinary luteinizing hormone ( LH ) monitoring in scheduling therapeutic donor insemination . DESIGN Participants were prospect ively r and omized to the BBT or LH groups . SETTING Participants were private patients of the Reproductive Endocrine Division at Washington University School of Medicine . PATIENTS Inclusion criteria were design ed to assure an isolated male factor . Seventy-four of 113 patients completed the study ; 18 had ongoing treatment at the end of the study . INTERVENTIONS  Basal body temperature graphs were physician interpreted and appointments prospect ively chosen . Luteinizing hormone patients monitored daily urine sample s and scheduled an appointment the day after the detected surge . MAIN OUTCOME MEASURES Fecundity rates , cumulative pregnancy rates , and cost per pregnancy were all prospect ively evaluated . RESULTS Life table analysis yielded a 6-month cumulative probability of pregnancy of 36.3 % in the LH group and 65.1 % in the BBT group ( P less than 0.025 ) . The total cost per pregnancy was lower in the BBT group ( + 6,212 versus + 3,997 ; P less than 0.001 ) . CONCLUSIONS This r and omized prospect i ve study demonstrates significant therapeutic and economic advantages when therapeutic donor insemination is prospect ively scheduled by BBT graphs The study 's objective was to determine if using human chorionic gonadotropin ( hCG ) as a timing method for intrauterine insemination ( IUI ) in patients who make mature follicles but have cervical factor problems has a negative effect on pregnancy rates ( PRs ) ( possibly by releasing an immature oocyte ) , or increases the rate of luteinized unruptured follicles ( LUF ) . Patients were offered hCG or natural release after an explanation of the theoretical advantages and disadvantages . Intrauterine insemination was performed 36 - 40 h after hCG ; timing of IUI with hCG was based on day of luteinizing hormone ( LH ) surge modified by serum progesterone ( P ) . Incidence of LUF in those taking hCG-5/116 ( 4.3 % ) ; 0/33 without hCG .  Pregnancies-24/116 ( 20 % ) with hCG ; 3/30 ( 10 % ) without hCG . No statistical differences in these rates were found . Thus , using hCG for more convenient timing for IUI in nonsuperovulated cycles does not decrease the PR or cause a high incidence of LUF OBJECTIVES To verify non-inferiority of the clinical pregnancy rate of Early hCG administration ( leading follicle sizes within 16.0 - 16.9 mm in diameter ) compared to Late hCG administration ( leading follicle sizes within 18.0 - 18.9 mm in diameter ) . STUDY DESIGN Prospect i ve r and omized trial . Six hundred and twelve infertile women c and i date s for intrauterine insemination ( IUI ) received HP-hMG 75 IU/day SC from cycle days 4 to 8 and then as per ovarian response . Ovulation was r and omly triggered ( hCG 5000 IU , IM ) when the leading follicle diameter ranged between either 16.0 and 16.9 mm ( Early hCG group , n=227 ) or 18.0 and 18.9 mm ( Late hCG group , n=207 ) and IUI was performed approximately 36 h later . RESULTS Whereas population and sperm characteristics were comparable in both groups , the number of follicles ≥ 14 mm in diameter ( P<0.007 ) and serum estradiol levels ( P<0.001 ) on the day of hCG were lower in the Early versus the Late hCG groups . Clinical ( 11.9 % versus 12.1 % ) and ongoing ( 11.0 % versus 8.6 % ) pregnancy rates per r and omized women were similar in the two groups and statistical non-inferiority of clinical and ongoing pregnancy rates was demonstrated . CONCLUSION These results suggest that hCG administered when the largest follicle size reaches 16.0 - 16.9 mm leads to similar clinical and ongoing pregnancy rates as when it reaches 18.0 - 18.9 mm in IUI cycles BACKGROUND The study objective was to investigate whether repeated intranasal administration of a GnRH agonist could provide convenient and safe luteal support . METHODS Twenty-four patients with unexplained infertility were enrolled . All patients were treated with an aromatase inhibitor . When ovulation trigger criteria were met , patients were r and omly allocated to either 5000 IU hCG ( group A ) , or 200 microg intranasal buserelin followed by 100 microg every 3 days ( group B ) , 100 microg every 2 days ( group C ) , or 100 microg every day ( group D ) , up to day 14 of the luteal phase . All patients underwent intrauterine insemination .  RESULTS Follicular development was similar in all groups with 1.1 + /- 0.3 follicles > or = 16 mm , 229.4 + /- 95.2 pg/ml estradiol ( E2 ) and 0.8 + /- 0.5 ng/ml progesterone ( mean+/-SD ) . The luteal phase duration ( median ; 95 % confidence interval ) was 15 ( 14.1 , 15.0 ) , 14 ( 12.5 , 15.5 ) , 15 ( 11.8 , 18.2 ) and 15 ( 14.4 , 15.6 ) days in groups A , B , C and D respectively . From luteal phase day 7 onwards , progesterone levels tended to be higher in group D compared with A. On day 14 of the luteal phase , progesterone levels were 3.0 ( 0.8 , 5.2 ) , 1.7 ( -0.5 , 3.9 ) , 3.9 ( -0.7 , 8.5 ) and 7.7 ( 3.4 , 11.9 ) ng/ml in groups A , B , C and D respectively ( P = 0.045 ) . No pregnancy was recorded in group A , but there was one biochemical pregnancy in group B , one biochemical and one singleton clinical pregnancy in group C , and two singleton clinical pregnancies in group D. CONCLUSION Intranasal administration of buserelin could be effective to provide luteal support . This treatment was associated with a good pregnancy rate ( 5/18 , 28 % ) BACKGROUND : The assessment of follicular maturity at the time of human chorionic gonadotropin ( hCG ) is one of the key factors for the success of all assisted reproductive techniques . AIM : To assess follicles by three dimensional ( 3D ) and 3D power Doppler ( PD ) before giving hCG to improve pregnancy rates in intrauterine insemination ( IUI ) cycles . DESIGN : Prospect i ve r and omized study . MATERIAL S AND METHODS : Ultrasound for pre-hCG follicular assessment was performed over a period of 10 months for all 1000 cycles of IUI .  Follicular assessment was performed using a transvaginal multifrequency volume probe .  Follicles considered mature by 2D US and color Doppler were assessed by 3D and 3D PD . These values were independently evaluated for the conception and the non-conception groups . RESULTS : Conception rates were 32.3 and 27 % respectively and individually when the perifollicular resistance index was < 0.50 and the peak systolic velocity was > 11 cm/s 10 - 12 h before hCG . Conception rates of 32 % were achieved with a follicular volume between 3 and 7 cc . The conception rate was 32.3 % in the cumulus group . A perifollicular vascularity index of between six and 20 gave conception rates of 35 % and perifollicular flow index of 27 - 43 gave conception rates of 33 % . CONCLUSIONS : 3D ultrasound is much more accurate for volume assessment of the follicle . Presence of cumulus increases the surety of the presence of a mature ovum in the follicle . 3D and 3D PD when used with 2D US and color Doppler for pre-hCG follicular assessment would definitely improve pregnancy rates in IUI cycles Purpose To compare the use of human chorionic gonadotropin ( hCG ) to a gonadotropin releasing hormone ( GnRH ) agonist , nafarelin , in initiating ovulation and supporting the luteal phase after priming with clomiphene . Methods In 26 infertile women 50 mg clomiphene citrate produced a preovulatory-size follicle . Then , 11 women were r and omized to receive two 400-μg doses of nafarelin intranasally 16 h apart , and 15 women were injected intramuscularly with 5000 IU of hCG ( luteal day 0 = LD0 ) . Starting on LD6 , 7 more 400-μg doses of nafarelin were repeated on an every 16-h schedule or a single 2500 IU dose of hCG was given , respectively . Serum levels of follicle stimulating hormone ( FSH ) , luteinizing hormone ( LH ) , estradiol ( E2 ) , progesterone ( P ) , and hCG were measured . On LD13 , endometrium was evaluated with ultrasonography and biopsy in 19 nonpregnant women . Results As judged by a threefold rise in serum LH , an LH surge was detected on LD1 in all 11 nafarelin patients , but in only 8 hCG patients ( P = 0.01 ) . LH and FSH levels were significantly higher on LD1 , 7 , and 8 and were significantly suppressed on LD13 in the nafarelin group . All patients had mid-luteal P levels greater than 10 ng/ml and luteal phases longer than 13 days . Significantly different luteal E2 or P levels were noted only on LD13 , with lower values in the nafarelin group . Pregnancies were achieved in 3 of 11 nafarelin cycles and 2 of 15 hCG cycles . Luteal phase defects were also similar : 4 of 8 nafarelin patients and 7 of 11 hCG patients . Conclusion Nafarelin or hCG in conjunction with clomiphene can result in viable pregnancies , but is associated with low pregnancy rates and a high incidence of luteal phase defects OBJECTIVES To compare the ability of a computerized method of sperm morphology with the manually recorded method in predicting in vitro fertilization ( IVF ) results , to compare results obtained by both methods , and to determine the intraobservation variability . DESIGN , SETTING , PATIENTS Forty-three stained semen slide preparations from two large level-three academic institutions ' reproductive endocrinology units ( IVF programs ) were blindly evaluated , and the sperm were classified into normal and amorphous forms . RESULTS Experiment 1 : Twenty-one slide preparations from the Tygerberg gamete intrafallopian transfer program  were manually evaluated ; the fertilization rates for the groups with < 14 % and > 14 % normal sperm forms were 33.3 % ( 15/45 oocytes ) and 76.6 % ( 46/60 oocytes ) , respectively . Corresponding fertilization rates with FERTECH were 46.8 % ( 30/64 ) and 75.6 % ( 31/41 ) . Experiment 2 : Twenty-two slide preparations from the Norfolk IVF program were evaluated . The manual method reported a fertilization rate in the group with < 14 % normal forms of 27.4 % ( 14/51 oocytes ) compared with 90.0 % ( 127/141 oocytes ) in the group with > 14 % normal forms . Corresponding figures for the FERTECH method were 33.9 % ( 18/53 ) and 88.4 % ( 123/139 ) , respectively . Experiment 3 : When the 43 slide preparations were blindly evaluated using both methods , 84 % of the FERTECH evaluations correlated well with the manual method and FERTECH ability to diagnose the subfertile male ( < 14 % normal forms ) was 95 % ( sensitivity ) . Experiment 4 : A total of 16 different slides ( 8 per group ) were r and omly selected and analyzed five times ( 100 cells per reading ) by the computerized method . The slides were obtained from men with normal sperm morphology of < 14 % and > 14 % as classified by the manual method . In the first group ( < 14 % ) 97.5 % ( 39/40 ) of the readings classified the sperm in the proper category , whereas in the second group ( > 14 % ) 95 % ( 38/40 ) of the cases were correctly identified . CONCLUSION Using strict criteria for morphology evaluation , there is a positive and significant correlation between FERTECH evaluation and manual assessment . The reproducibility of the computerized method and the ability to distinguish between fertile and subfertile groups using those criteria are good STUDY QUESTION What is the impact on pregnancy rates when intrauterine insemination ( IUI ) is performed 1 or 2 days after the spontaneous LH rise ? SUMMARY ANSWER I 
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We found no evidence of a difference between any of the groups in rates of pregnancy or adverse events ( multiple pregnancy , miscarriage , ovarian hyperstimulation syndrome ( OHSS ) ) .
There is insufficient evidence to determine whether there is any difference in safety and effectiveness between different methods of synchronization of ovulation and insemination .