***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 : Implantation is considered as the rate-limiting step in success of assisted reproduction techniques , and intrauterine insemination cycles . It might be affected by ovarian superovulation and endometrial local scratching . Objective : This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles . Material s and Methods : In this r and omized clinical trial 144 women with unexplained infertility , mild male factor , and mild endometriosis r and omly divided into two study groups through block r and omization . The patients were r and omly assigned to undergo endometrial biopsy between days 6 - 8 of the previous menstrual cycle before IUI ( n=72 , IUI cycles = 126 ) or receive no interventions ( n=72 , IUI cycles=105 ) . Results : The pregnancy rate per patient was 17 ( 23.6 % ) and 14 ( 19.4 % ) in endometrial biopsy and control groups , respectively ( p=0.686 ) . The pregnancy rate per cycle was 17/126 ( 13.5 % ) and 14/105 ( 13.3 % ) in endometrial biopsy and control groups , respectively ( p=0.389 ) . The abortion rate was comparable between the two groups ( 6.9 % vs. 9.7 % ; p=0.764 ) . The ongoing pregnancy rate was found to be comparable between the two study groups , as well ( 16.7 % vs. 9.7 % ; p=0.325 ) . Endometrial thickness ( p=0.609 ) was comparable between the groups ; however E2 was significantly lower in the endometrial biopsy group ( p<0.001 ) . Conclusion : Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle , decreased abortion , and increased endometrial thickness Background : Unexplained infertility is still a challenging issue as to its causes , appropriate management and treatment . Evidence implicates early embryopathy or implantation failure as likely causes . Objective : This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients . Material s and Methods : This was a r and omized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital . A total of 217 women with unexplained infertility aged 23 - 35 years old were r and omly divided into two study groups through block r and omization . After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18 - 20 mm , patients were r and omly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling ( n=114 ) or mock pipette biopsy ( n=103 ) during pre-ovulatory days ( when spontaneous urinary LH surge was detected ) . Then all the patients were instructed to follow a regularly timed intercourse . Results : The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [ 17/114 ( 14.9 % ) vs. 6/103 ( 5.8 % ) ( OR : 2.83 95 % CI : 1.07 - 7.49 , p=0.03 ] . The abortion rate was comparable between two groups ( 17.64 % vs. 14.28 % ; p=0.701 ) . Conclusion : Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation . This simple , easy , and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments . This procedure may help reduce psychological tensions and high expenses imposed through such interventions . Registration ID in I RCT : I RCT Objective The aim of this work was to compare the pregnancy rates during IUI cycles with or without endometrial sampling . Study design A prospect i ve , r and omized study . Patients and methods 150 patients were recruited . They were classified into three groups . Each comprised 50 patients . Group 1 was considered the control group and underwent IUI with no endometrial sampling . Group 2 underwent Tao Brush endometrial sampling on day 8–9 of the uterine cycle that preceded the stimulation cycle , and finally , Group 3 underwent Tao Brush endometrial sampling on day 8–9 of the same IUI cycle Outcome of the study A positive pregnancy test . Results Pregnancy percentages were 18 , 38 , and 36 % for group 1 , group 2 , and group 3 , respectively . The paired t test was used to compare each two individual group means . The results show a highly significant value for the paired t test of the control group and group 2 of the patients ( p = 0.001 ) , as well as a highly significant results ( p = 0.002 ) for the group 3 and the control group . No significant value was present between the group 2 and 3 of patients ( p = 0.322 ) . Conclusion Endometrial sampling significantly increases pregnancy rates in IUI procedures when it is done in the proliferative phase of the IUI cycle , or the cycle prior to IUI , than pregnancy rates with IUI alone OBJECTIVE To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure . DESIGN Cross-sectional survey . SETTING Not applicable . PATIENT(S ) A nationally representative sample of females aged 15 - 44 years . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Infertility prevalence estimated by two approaches : [ 1 ] a constructed measure derived from questions on sexual activity , contraception , relationship status , and pregnancy , and [ 2 ] a measure based on estimated time to pregnancy derived from the respondents ' current duration of pregnancy attempt ( i.e. , current duration approach ) . Associations with self-reported descriptive characteristics using weighted logistic regression or parametric survival models for each respective approach . RESULT ( S ) Infertility prevalence was approximately twofold higher using the current duration approach ( 15.5 % ; 95 % confidence interval 8.6%-27.5 % ) vs. the constructed measure ( 7.0 % ; 95 % confidence interval 6.2%-7.8 % ) . Both methods identified similar patterns of increasing age , lower education , nulliparity , and history of gynecologic disorders as being associated with measures of impaired fecundity , whereas opposing patterns were seen for racial/ethnic identification and poverty status . CONCLUSION ( S ) Infertility prevalence based on a current duration approach was consistent with other US prospect i ve cohort studies with preconception enrollment . These findings underscore the importance of definition and method ologic approach for estimating the prevalence of infertility Objective : To explore the impact of endometrial scratch injury ( ESI ) on  intrauterine insemination ( IUI ) success . Methods : One hundred and fifty four infertile women received 100 mg of oral clomiphene citrate for 5 days starting on day 3 of the menstrual cycle . Patients were r and omized to 2 equal groups : Group C received IUI without ESI and group S had ESI .  Successful pregnancy was confirmed by ultrasound . Results : 13 , 21 , and 10 women got pregnant after the first , second , and third IUI trials , respectively , with 28.6 % cumulative pregnancy rate ( PR ) . The cumulative PR was significantly higher in group S ( 39 % ) compared to group C ( 18.2 % ) . The PR in group S was significantly higher compared to that in group C at the second and third trials . The PR was significantly higher in group S at the second trial compared to that reported in the same group at the first trial but nonsignificantly higher compared to that reported during the third trial , while in group C , the difference was nonsignificant . Eight pregnant women had first trimester abortion with 18.2 % total abortion rate with nonsignificant difference between studied groups . Conclusion : The ESI significantly improves the outcome of IUI in women with unexplained infertility especially when conducted 1 month prior to IUI STUDY QUESTION What was the clinical and economic impact of universal coverage of IVF in Quebec , Canada , during the first calendar year of implementation of the  public IVF programme  ? SUMMARY ANSWER Universal coverage of IVF increased access to IVF treatment , decreased the multiple pregnancy rate and decreased the cost per live birth , despite increased costs per cycle . WHAT IS KNOWN ALREADY Public funding of IVF assures e quality of access to IVF and decreases multiple pregnancies result ing from this treatment . Public IVF programmes usually m and ate a predominant SET policy , the most effective approach for reducing the incidence of multiple pregnancies . STUDY DESIGN , SIZE , DURATION This prospect i ve comparative cohort study involved 7364 IVF cycles performed in Quebec during 2009 and 2011 and included an economic analysis . PARTICIPANTS / MATERIAL S , SETTING , METHODS  IVF cycles performed in the five centres offering IVF treatment in Quebec during 2009 , before implementation of the public IVF programme  , were compared with cycles performed at the same centres during 2011 , the first full calendar year following implementation of the programme . Data were obtained from the Canadian Assisted Reproductive Technologies Register ( CARTR ) . Comparisons were made between the two periods in terms of utilization , pregnancy rates , multiple pregnancy rates and costs . MAIN RESULTS AND THE ROLE OF CHANCE The number of IVF cycles performed in Quebec  increased by 192 % after the new policy was implemented . Elective single-embryo transfer was performed in 1.6 % of the cycles during Period I ( 2009 ) , and increased to 31.6 % during Period II ( 2011 ) ( P < 0.001 ) . Although the clinical pregnancy rate per embryo transfer was lower in 2011 than in 2009 ( 24.9 versus 39.9 % , P < 0.001 ) , the multiple pregnancy rate was greatly reduced ( 6.4 versus 29.4 % , P < 0.001 ) . The public IVF programme increased government costs per IVF treatment cycle from CAD$3730 to CAD$4759 . Despite increased costs per cycle , the efficiency defined by the cost per live birth , which factored in downstream health costs up to 1 year post delivery , decreased from CAD$49 517 to CAD$43 362 per baby conceived by either fresh and frozen cycles . LIMITATIONS , REASONS FOR CAUTION The costs described in the economic model are likely an underestimate as they do not factor in many of the long-term costs that can occur after 1 year of age . The information collected in the Canadian ART register precludes the calculation of cumulative pregnancy rates . WIDER IMPLICATION S OF THE FINDINGS Our study confirms that the implementation of a public IVF programme favouring eSET not only sharply decreases the incidence of multiple pregnancy , but also reduces the cost per live birth . STUDY FUNDING /COMPETING INTEREST(S ) M.P.V. holds a fellowship award from the Canadian Institutes of Health Research ( CIHR ) . The economic analysis performed by M.P.C. was supported by an unrestricted grant from Ferring Pharmaceutical OBJECTIVE To study whether an injury-induced inflammation might be the mechanism underlying the favorable effect of endometrial biopsy on the implantation rate in in vitro fertilization ( IVF ) patients . DESIGN Controlled clinical study . SETTING A medical center IVF unit and a research institute . PATIENT(S ) Women undergoing IVF who had previous failed treatment cycles . INTERVENTION(S ) Endometrial sample s were collected from two groups of patients on day 21 of their spontaneous menstrual cycle . The experimental , but not the control group underwent prior biopsy treatment on days 8 or/ and 11 to 13 of that same cycle . MAIN OUTCOME MEASURE(S ) Abundance of immune cells , cytokines/chemokines level , correlation between these parameters and pregnancy outcome . RESULT ( S ) A statistically significantly higher amount of macrophages/dendritic cells ( HLA-DR+ CD11c+ cells ) and elevated proinflammatory cytokines , tumor necrosis factor-α ( TNF-α ) , growth-regulated oncogene-α ( GRO-α ) , interleukin-15 ( IL-15 ) , and macrophage inflammatory protein 1B ( MIP-1B ) , were detected in day-21 endometrial sample s of the experimental group . A direct stimulatory effect of TNF-α on MIP-1B , GRO-α , and IL-15 messenger RNA ( mRNA ) expression was demonstrated . A positive correlation was found between the levels of macrophages/dendritic cells , MIP-1B expression , and TNF-α expression and the pregnancy outcome . CONCLUSION ( S ) A biopsy-induced inflammatory response may facilitate the preparation of the endometrium for implantation . Increased MIP-1B expression could possibly serve for prediction of implantation competence OBJECTIVE : The objective was to evaluate the effect of endometrial biopsy ( EB ) on  intrauterine insemination ( IUI )  outcome in controlled ovarian stimulation ( COS ) cycle . DESIGN : Prospect i ve r and omized control study . SETTING : Tertiary care center . MATERIAL S AND METHODS : A total of 251 subjects were enrolled in the study . Subjects undergoing COS with IUI  were r and omly allocated into three groups . Group A : EB was taken between D19 and 24 of the spontaneous 
    Output:
    
The primary outcomes were live birth/ongoing pregnancy and pain experienced during the procedure .
It is uncertain whether endometrial injury improves the probability of pregnancy and live birth/ongoing pregnancy in women undergoing IUI or attempting to conceive via sexual intercourse .