***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 the clinical results and the cost effectiveness of urinary FSH and recombinant FSH in ovarian stimulation for IUI cycles . DESIGN Prospect i ve , r and omized trial . SETTING University Hospital , Perugia , and A.G.UN.CO . Obstetrics and Gynaecology Centre , Rome , Italy . PATIENT(S ) IUI cycles were performed in 67 infertile patients . INTERVENTION(S ) Protocol s of ovarian stimulation with urinary FSH or recombinant FSH were r and omly assigned , for a total of 138 cycles performed ( 67 and 71 , respectively ) . MAIN OUTCOME MEASURE(S ) Number of mature follicles , days of stimulation , number of ampules , and IU used per cycle , biochemical/ clinical pregnancy rates and cost-effectiveness ratio . RESULT ( S ) Follicular development , length of stimulation , pregnancy and delivery rates were not statistically different . Although in the urinary FSH group a significantly higher number of IU of gonadotropins were used ( 815.5 + /- 284.9 vs. 596.0 + /- 253.8 ) , the cost per cycle remained significantly lower ( 220.73 + /- 94.72 vs. 318.50 + /- 125.21 ) . The cost-effectiveness ratio was 1,848.61 euro in the urinary FSH group and 2,512.61 euro in the recombinant FSH group . CONCLUSION ( S ) Urinary FSH and recombinant FSH are both effective in ovarian stimulation in IUI cycles . The urinary preparation is more cost effective due to the difference of its cost per IU BACKGROUND The study was conducted to compare the results of  intrauterine donor insemination ( DI )  under ovarian stimulation with either clomiphene citrate ( CC ) , in a fixed protocol , or FSH , with ovarian monitoring . METHODS Forty-nine patients were r and omized using a computer-generated list to receive highly purified urinary FSH ( starting dose of 150 IU ) and were subjected to periodic vaginal ultrasound and estradiol determinations . HCG was given when > or = 2 follicles ( > or = 17 mm ) were identified and estradiol reached > 400 pg/ml . Intrauterine insemination ( IUI ) was performed 36 h later . The other 51 received CC on a fixed protocol ( 100 mg/day from the day 5 - 10 of the ovarian cycle ) with HCG being administered on the day 12 , and IUI performed 36 h later . Up to six IUI cycles were performed on all patients if pregnancy was not reached before . Women failing to conceive in the CC group underwent IUI with FSH . The main outcome measures were intrauterine gestational sac observed by transvaginal ultrasound , per cycle and per woman pregnancy rate ( PR ) and multiple PR . RESULTS The per cycle PR was significantly higher in the FSH group , 14.4 % ( 30/209 ) versus 6.1 % ( 16/261 ) , as well as the per woman PR , 61.2 % ( 30/49 ) versus 31.4 % ( 16/51 ) . 12.5 % ( 2/16 ) of pregnancies obtained in the CC group were multiple , compared with 20 % ( 6/30 ) in the FSH group . There were no triplets or higher order pregnancies in CC versus two in FSH ( 6.7 % of pregnancies ) . Patients failing to conceive with CC , who later underwent intrauterine DI with FSH , had similar results to the primary FSH group : 54.3 % PR per patient ( 19/35 ) and 16.0 % per cycle ( 19/118 ) , with a multiple PR of 31.6 % ( 6/19 ) . The PR for women starting with CC cycles and , if pregnancy was not obtained , continuing with six FSH cycles , was 69.2 % . CONCLUSIONS The PR obtained with CC stimulation was approximately half that obtained with FSH . There was a trend to lower multiple PR with CC . It is recommended that each case should be considered on an individual basis and the treatment options discussed with patients . In our opinion , CC could be a reasonable approach for young women with good prognosis , whereas in the remaining cases FSH would be the preferable method The aim of this prospect i ve , r and omized trial was to compare the clinical results and the cost-effectiveness of urinary FSH ( uFSH ) and recombinant FSH ( rFSH ) in ovarian stimulation for intrauterine insemination ( IUI ) cycles in polycystic ovary syndrome ( PCOS ) patients . One-hundred and seventy PCOS infertile patients undergoing IUI were enrolled , and protocol s of ovarian stimulation with uFSH or rFSH were r and omly assigned . The total number of cycles performed was 379 ( 182 and 197 , respectively ) . The main outcome measures were the number of mature follicles , the days of stimulation , the number of ampoules and IU used per cycle , the biochemical/ clinical pregnancy rates , the number of multiple pregnancies and the cost-effectiveness . No statistically significant differences were found in the follicular development , length of stimulation , pregnancy rates , delivery rates and multiple pregnancies between the two groups . In the uFSH group , the cost per cycle remained significantly lower ( 218.51 + /- 88.69 versus 312.22 + /- 118.12 ; P < 0.0001 ) , even though a significantly higher number of IU of gonadotrophins were used ( 809.3 + /- 271.9 versus 589.1 + /- 244.7 ; P < 0.0001 ) . The cost-effectiveness ( i. e. within a group , the total cost of all cycles divided by no. of clinical pregnancies ) was 1729.08 in the uFSH group and 3075.37 in the rFSH group . In conclusion , uFSH and rFSH demonstrated the same effectiveness in ovarian stimulation in IUI cycles in PCOS patients . The urinary preparation is more cost-effective due to the difference of its cost per IU 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 r and omized trial was carried out comparing recombinant FSH ( rFSH ) and highly purified urinary FSH ( uFSH ) in intrauterine insemination ( IUI ) with husb and s ' spermatozoa . A total of 45 women received rFSH ( 139 cycles ) , while 46 women received uFSH ( 155 cycles ) . The starting dose was 150 IU/day s.c . , beginning on the second day , and on days 6 - 7 the dose was adjusted according to ovarian response , assessed by vaginal ultrasound and plasma oestradiol concentration . The pregnancy rate according to the intention to treat was 57.8 % in rFSH versus 52.2 % in uFSH , the corrected pregnancy rates 56.8 % and 52.2 % , and the cumulative pregnancy rates 69.6 % and 61.0 % , but the differences were not statistically significant . The per cycle pregnancy rate was 18.12 % in rFSH and 15.48 % in u-FSH , also not statistically significant . In the rFSH  group , the consumption of FSH ampoules per cycle was significantly lower ( 19.20 + /- 7.02 versus 23 . 80 + /- 10.78 ; P < 0.0001 ) . The ratio of oestradiol/FSH ampoules was significantly higher in rFSH ( 56.45 + /- 31.26 versus 46.41 + /- 29 . 25 ; P < 0.001 ) . These data indicate that , in IUI cycles , rFSH has a higher potency than uFSH BACKGROUND A comparison of the effectiveness of different gonadotrophin preparations in intrauterine insemination ( IUI ) cycles for patients with unexplained infertility was performed . METHODS Two hundred and forty-one patients were prospect ively r and omized using computer-generated r and om numbers into three groups : 81 in the Follitropin alpha ( Group I ) , 80 in the urinary FSH ( uFSH ) ( Group II ) and 80 in the hMG ( Group III ) . The primary outcome was clinical pregnancy rate with duration of stimulation , total gonadotrophin dose , number of dominant follicles , clinical pregnancy rate , multiple pregnancy , miscarriage rate and ovarian hyperstimulation syndrome ( OHSS ) rate being secondary outcomes . RESULTS Clinical pregnancy rate was significantly higher in the rFSH group ( 25.9 % in Follitropin alpha , 13.8 % in uFSH and 12.5 % in HMG groups ; P = 0.04 ) . There was no significant difference in terms of duration of stimulation , but mean FSH dose consumed per cycle was significantly lower in the recombinant FSH ( rFSH ) group compared with others ( 825 IU in Follitropin alpha , 1107 IU in uFSH and 1197 IU in HMG groups ; P = 0.001 ) . The number of follicles > or = 16 mm diameter was significantly higher in the rFSH group compared with the uFSH and HMG groups ( 2.6 in Follitropin alpha , 1.3 in uFSH and 1.4 in HMG groups ; P = 0.001 ) . CONCLUSION rFSH may result in a better outcome in IUI cycles for unexplained infertility The clinical efficacy of commercial gonadotrophin preparations  has been the subject of an intense debate during recent years . Arguments have primarily focused on the origin of FSH activity ( urine versus recombinant derived ) and whether the preparation included LH-like activity . FSH isoform composition has received little or no attention , and is usually considered to have negligible effect on clinical effectiveness . By presenting the available data on the FSH isoform composition of commercial gonadotrophin preparations , the present paper challenges this assumption . To evaluate whether the FSH isoform composition affected the efficacy of a product , a meta- analysis was performed that compared a preparation expressing an acidic isoform profile ( urinary-derived Metrodin-HP ) with a preparation rich in less acidic isoforms ( recombinant derived Gonal F ) . A total of five r and omized clinical trials that specifically compared these two preparations was identified and included in the analysis . All parameters relating to the direct effect of FSH on the follicle differed significantly in favour of the product rich in less acidic isoforms , while data on pregnancy outcome did not reach significance . The importance of the FSH isoform profile and whether the FSH is derived from urine or by recombinant technique is discussed in relation to clinical efficacy . It is suggested that the FSH isoform profile of commercial gonadotrophin preparations is of clinical importance and should be taken into account when evaluating efficacy OBJECTIVE To demonstrate the noninferiority of highly purified menotropin ( HP-hMG ) compared with recombinant FSH ( rFSH ) regarding clinical pregnancy rate ( PR ) in intrauterine insemination ( IUI ) cycles . DESIGN Prospect i ve r and omized noninferiority trial . SETTING Unit of physiopathology of human reproduction , university hospital . PATIENT(S ) Five hundred twenty-three patients with unexplained infertility or mild male infertility undergoing controlled ovarian hyperstimulation for IUI . INTERVENTION(S ) Patients were r and omized for treatment with rFSH ( 262 patients ) or HP-hMG ( 261 patients ) .  Insemination was performed 34 - 36 hours after hCG injection . MAIN OUTCOME MEASURE(S ) The primary outcome was clinical pregnancy rate ( PR ) . The secondary outcome was the number of interrupted cycles for high risk of o 
    Output:
    
( S ) Rec-FSH was associated with higher per cycle PR than HP-FSH , when used at the same dose , whereas the PR were similar when the dose of rec-FSH was 50 % lower