***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 
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    Input: Ovarian stimulation combined with intra-uterine insemination ( IUI ) is an effective treatment of non-tubal infertility but most women undergo several cycles of treatment to achieve a pregnancy . This prospect i ve study was design ed to assess the consistency ( or variation ) of ovarian responses and the effect of various ovarian stimulation protocol s on this consistency in consecutive cycles of ovarian stimulation and IUI in women with non-ovulatory infertility . A total of 86 regularly menstruating ovulating patients each completed three to six cycles of ovarian stimulation and IUI ( n = 347 cycles ) . Ovarian stimulation was achieved by sequential clomiphene citrate/human menopausal gonadotrophin ( HMG ) , HMG-only or combined gonadotrophin-releasing hormone analogue -- HMG protocol s in 33 , 29 and 24 patients respectively , and each patient used the same protocol consistently throughout the study . St and ard methods were used to monitor ovarian response and to perform  IUI .  Using each patient as her own control , repeated measurements analysis of variance revealed consistency of ovarian response in consecutive ovarian stimulation cycles , as shown by the number and mean diameter of maturing pre-ovulatory follicles , peak plasma oestradiol , duration of stimulation and mean HMG requirements . This consistency existed using any of the ovarian stimulation protocol s. We conclude that regularly menstruating and ovulating women are likely to have similar ovarian responses in consecutive cycles of ovarian stimulation and IUI if the same ovarian stimulation protocol is used consistently . ( ABSTRACT TRUNCATED AT 250 WORDS Superovulation was performed prospect ively with pure follicle stimulating hormone ( FSH ) to a group of 224 infertile patients with ovulatory factor ( 51 ) , male factor ( 60 ) , mild/moderate endometriosis ( 24 ) and unexplained infertility ( 72 ) . The aim was to produce three or four leading follicles in order to compensate for a ' deficient ' factor . Ovulation was induced with human chorionic gonadotrophin ( HCG ) and monitoring was performed entirely by serial transvaginal ultrasound on alternate cycles up to a maximum of six cycles ( 1120 treatment cycles ) with intervening cycles being used as self-controls ( 932 rest cycles ) . A further control group of 56 patients was matched for age , category and duration of infertility and was only scanned serially ( 336 control cycles ) . Seventy-four pregnancies were achieved and 54 delivered , giving a cumulative pregnancy rate per couple of 33 % and a cumulative take home baby rate of 24 % per couple after a maximum of six cycles of treatment . When compared with the rest or control cycles , treatment was significantly effective for ovulatory ( P < 0.001 ) , mild/moderate endometriosis ( P < 0.01 ) and unexplained infertility ( P < 0.01 ) but not for male infertility . Furthermore , pregnancy was five times more likely during the first four treatment cycles ( P = 0.00006 , odds ratio = 5 ) at the expense of a significant multiple pregnancy rate ( 18.9 % ) and mild/moderate ovarian hyperstimulation rate ( 12 % ) . We conclude that four cycles of superovulation should be routinely offered to couples on waiting lists for assisted conception or to those unable to afford it , in anovulatory , mild/moderate endometriosis and unexplained infertility . These results need confirmation by a prospect i ve multi-centre r and omized study OBJECTIVE To determine whether crossover trials with simple pooling of data over different study periods leads to a different estimate of treatment effect compared with parallel group trials in infertility research using pregnancy as the outcome measure . DESIGN An observational study using nine overviews that included trials with both crossover and parallel group design s. These overviews comprised 17 crossover and 17 parallel group trials . In total , there were 5,291 outcomes including 775 pregnancies . The association between study design and treatment effect estimate was analyzed using multiple logistic regression , controlling for differences in the therapeutic interventions and variations in the method ological quality of the trials . SETTING Infertile patients in an academic research environment . PATIENTS Infertile patients undergoing treatment efficacy evaluation in controlled trials . INTERVENTIONS R and om allocation to a variety of treatments including clomiphene citrate , hCG , IUI , tamoxifen , and bromocriptine . MAIN OUTCOME MEASURE Estimate of bias between study design s , based on the interaction of study design and treatment in the logistic regression model . RESULTS Crossover trials produced a larger average estimate of treatment effect compared with trials with a parallel group design , overestimating the odds ratio by 74 % ( 95 % confidence interval , 2 % to 197 % ) . CONCLUSION The use of a crossover design for evaluating infertility treatments with outcomes that prevent patients from completing later phases of the trial should be avoided because it leads to exaggerated estimates of treatment effect and may result in erroneous inferences and clinical decisions . Furthermore , the type of study design should be taken into account when assessing the method ological quality of therapy trials in infertility OBJECTIVE To assess the prognostic value of strict sperm morphology analysis in  intrauterine insemination with husb and 's sperm ( IUI ) cycles performed because of male infertility . DESIGN Prospect i ve study . SETTING Academic tertiary hospital . PATIENTS Seventy-four consecutive couples subjected to 271 IUI cycles because of male infertility . MAIN OUTCOME MEASURE Strict morphology analysis 1 month before the beginning of IUI following the criteria of Kruger et al. RESULTS Pregnancy and no pregnancy couples were similar regarding strict normal forms ( 2.85 % + /- 2.07 % versus 3.13 % + /- 2.63 % ) , slightly amorphous forms , and the morphology index ( 11.79 + /- 6.06 versus 12.04 + /- 7.13 ) . Pregnancy rates ( PRs ) were similar when normal forms were < 4 % ( 39.1 % ) or > 4 % ( 35.7 % ) . The PR , although higher in the group with morphology index > 10 % ( 41.4 % ) than in the group < 10 % ( 33.3 % ) , lacked statistical significance . In pure male infertility group , mean values of morphology were similar in pregnancy and nonpregnancy group . A not significant trend was detected toward higher PRs in morphology index > 10 % ( 50.0 % ) than in the group < 10 % ( 33.3 % ) . CONCLUSION Strict morphology analysis 1 month before the beginning of IUI is not a useful prognostic factor in IUI performed because of male infertility A prospect i ve trial was undertaken to evaluate the efficacy of stimulated in-vitro fertilization ( SIVF ) and stimulated intrauterine insemination ( SIUI ) in couples with unexplained and mild male factor infertility . In all , 80 couples were allocated to treatment with SIVF or SIUI , both treatments following the same protocol [ clomiphene citrate and follicle stimulating hormone ( FSH ) injection ] , except that higher doses of FSH were used in the SIVF treatment cycles . Initially , 41 couples were allocated to and started treatment with SIVF but eight cases were eventually converted to SIUI because of under-response . Similarly , although 39 couples were initially allocated to SIUI treatment , five of these converted to SIVF because of over-response . The treatment cycles that were converted either to SIUI or to SIVF were not considered as treatment failures but as treatment changes and so were included in the analyses . Of the final 38 SIVF cycles , four were cancelled ( dysfunctional response ) , failed fertilization occurred in five cycles and 29 subjects reached embryo transfer . There were two biochemical pregnancies [ positive human chorionic gonadotrophin ( HCG ) only ] , two clinical abortions and seven live births . Of the final 42 SIUI cycles , only two were cancelled , insemination being performed in the remaining 40 cases . The result was one clinical abortion , three ectopics and eight live births . The proportion of cycles with positive HCG was identical ( 28.9 % per cycle treated for SIVF and 28.6 % for SIUI ) and the livebirth rates were also not different ( 18.4 % per cycle treated for SIVF and 19.0 % for SIUI ) . The cost per maternity of SIUI was approximately half that of SIVF ( Pounds Sterling 1923 versus Pounds Sterling 4611 ) and so we conclude that , as SIUI had an efficacy that was not significantly different from SIVF ( using similar protocol s ) but was more cost-effective , it must be considered the more appropriate form of management for the treatment of unexplained and mild male factor infertility . Indeed , it is hard to justify the routine use of IVF , as a first approach , in unexplained infertility BACKGROUND We aim ed to investigate whether sperm DNA quality may predict intrauterine insemination ( IUI ) outcome . METHODS The study was design ed in a prospect i ve cohort fashion , at a tertiary centre for reproductive medicine . A total of 119 patients underwent 154 cycles of IUI .  Parameters related to demography , cycle management and semen sample used for IUI were evaluated . Conventional semen parameters , morphology ( strict criteria ) , sperm DNA fragmentation and stability [ evaluated by terminal deoxynucleotidyl transferase-mediated dUDP nick-end labelling ( TUNEL ) and acridine orange staining under both acid and acid + heat denaturing conditions respectively ] were measured . The main outcome measure was clinical pregnancy , defined as ultrasonographic visualization of intrauterine gestational sac(s ) . RESULTS Logistic regression analyses were done on six sets of data , including all cycles combined , cycles with washed sample s , first cycle of each couple , first cycle of each couple with washed sample s , cycles stimulated with gonadotrophins and finally gonadotrophin-stimulated cycles with washed sample s. The number of pre-ovulatory follicles on day of hCG , the age of the woman and the percentage of sperm with acid- + heat-resistant DNA were the parameters that predicted IUI outcome in most of these data subsets . For the gonadotrophin-stimulated cycles , age of the man appeared as a predictor as opposed to that of the woman ; and for the cycles within this subgroup , where the semen sample was washed , sperm DNA fragmentation and age of the man were the only two parameters to predict IUI outcome . No sample s with > 12 % of sperm having DNA fragmentation result ed in pregnancy . CONCLUSIONS The number of follicles , age of the woman/man and sperm DNA quality may predict IUI outcome Crossover studies have been successfully conducted in the case of continuous responses . Existing procedures of analysis for ordinal responses , on the other h and , are rarely satisfactory unless strict , usually unrealistic , assumptions are made . In this paper we investigate a  r and om effects model  and show that the model is simple and general . Interpretation of parameters is easy , though with a complicated fitting procedure BACKGROUND The high iatrogenic multiple pregnancy rate associated with intrauterine insemination ( IUI ) in hyperstimulated cycles is becoming less acceptable . Therefore we investigated data from an earlier prospect i ve trial with regard to the specific question of whether the application of mild hyperstimulation in IUI cycles could be an alternative strategy for obtaining acceptable pregnancy rates while preventing a high multiple pregnancy rate , compared with natural cycles for IUI . METHODS Pregnancy outcome of 310 natural and 334 mildly hyperstimulated cycles for IUI in 171 couples with unexplained or mild male factor subfertility was analysed on a patient level with r and om coefficient models . RESULTS Pregnancy rates were similar : 35 and 39.8 % per couple in the natural and mildly hyperstimulated cycles respectively ( P = 0.60 ) . Multiple pregnancies , all twin pregnancies , were conceived significantly more frequently in the mild hyperstimulation group ( 27 % of the pregnancies ) than in the natural cycle group ( 4 % of the pregnancies ) ( P = 0.01 ) . All multiple pregnancies in the hyperstimulation group were conceived in multifollicular cycles . Multifollicular development was strongly associated with the application of mild hyperstimulation only ( odds ratio 21.14 , 95 % confidence interval 8.15 - 54.79 ) . CONCLUSION The application of a mild hyperstimulation protocol as an alternative to a st and ard hyperstimulation protocol for IUI does not result in higher pregnancy rates than IUI in the natural cycle , while at the same time multiple pregnancies can not be avoided . Therefore , there is no place for the use of gonadotrophins in IUI treatment BACKGROUND With the occasional reports of unexpectedly poor ovarian response to  controlled ovarian hyperstimulation ( COH ) for IVF in young normally cyclic women in mind , we studied age-related ovarian response to COH  in a group of women who underwent st and ard IVF .  METHODS Ovarian response to COH  was defined as the number of follicles > or = 14 mm on the day of hCG administration . Ovarian response to COH  was analysed by multiple regression analysis with woman 's age and basal FSH concentration as explanatory variables in a prospect i ve cohort of patients with idiopathic and mild male factor subfertility ( n = 85 ) , and additionally in a large retrospective cohort of women with unexplained , mild male and tubal 
    Output:
    
There was insufficient evidence of effectiveness to recommend or advise against IUI with or without OH above TI , or vice versa .