***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: Problems arising from controlled ovarian hyperstimulation for intrauterine insemination , such as premature luteinization and asynchronous ovarian follicular development , are identical to those encountered with controlled ovarian hyperstimulation for in vitro fertilization ( IVF ) and gamete intrafallopian transfer ( GIFT ) . It has been suggested that the adjunctive use of GnRH agonists for controlled ovarian hyperstimulation improves the efficiency of GIFT and IVF cycles . We hypothesized that adjunctive use of leuprolide acetate , a GnRH agonist , would have a similarly beneficial effect on cycle quality and cycle fecundity in subfertile women treated with controlled ovarian hyperstimulation and intrauterine insemination . We r and omly assigned the first cycle of controlled ovarian hyperstimulation and intrauterine insemination for each of 97 subfertile women to include either human menopausal gonadotropins ( hMGs ) alone or hMGs following midluteal pre-treatment with leuprolide . If a pregnancy did not occur in the first cycle , the woman was given the other treatment in the second cycle . Although the cycles that included leuprolide required a larger amount of hMGs and more days of stimulation per cycle , the mean estradiol concentrations and numbers of follicles were not different . Despite prevention of premature luteinization with leuprolide , the cycle fecundity was not different between groups ( 0.11 with adjunctive leuprolide treatment and 0.22 with hMGs alone ) . We conclude that in unselected subfertile patients , the adjunctive use of leuprolide for controlled ovarian hyperstimulation and intrauterine insemination does not improve cycle fecundity compared with treatment cycles that do not include adjunctive leuprolide therapy This pilot study was conducted to compare the results of intrauterine insemination ( IUI ) under ovarian stimulation with either letrozole ( Femara ) or human menopausal gonadotrophin ( HMG ) . A r and omized controlled trial was conducted . Eighty women aged 20 - 35 years with unexplained infertility of at least 2 years ' duration were r and omized according to a computer-generated r and omization list into the letrozole group and the HMG group . Letrozole was administered at 5 mg/day from day 3 to day 7 of the IUI cycle . HMG injections were started on day 3 at a dose of 75 IU for women under 30 years old and 150 IU for women over 30 years old and monitored periodically by vaginal ultrasound and oestradiol concentrations . The variables selected for analysis were clinical pregnancy rate , endometrial thickness , length of follicular phase and number of preovulatory follicles . No statistically significant difference in clinical pregnancy rates per cycle was found for patients in the letrozole or HMG group ( 18.4 versus 15.7 % ) . Cost was significantly higher in the HMG stimulation cases ( P < 0.001 ) and no injections were required in the letrozole group . In conclusion , letrozole offers a new treatment regimen in ovarian stimulation regimens for IUI that is cost effective , simple and convenient for the patients 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 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 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 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 We aim ed to assess the efficacy of a GnRH antagonist in intrauterine insemination ( IUI ) cycles to increase number of mature ovulatory follicles and pregnancy rates . METHODS Prospect i ve r and omized study . Women ( 18 - 38 years old ) with primary / secondary infertility were included . Eighty-two patients were r and omly assigned to  controlled ovarian stimulation  ( COS ) consisting of rFSH + GnRH antagonist or rFSH alone . RESULTS A non-significant increase in the total amount of rFSH was seen in the GnRH antagonist group ( 707+/-240 IU ) with respect to the control group ( 657+/-194 IU ) . The number of mature follicles ( > or = 16 mm ) was significantly higher in 
    Output:
    
Robust evidence is lacking but based on the available results gonadotrophins might be the most effective drugs when IUI is combined with ovarian hyperstimulation .
When gonadotrophins are applied it might be done on a daily basis .
When gonadotrophins are used for ovarian stimulation low dose protocol s are advised since pregnancy rates do not differ from pregnancy rates which result from high dose regimen , whereas the chances to encounter negative effects from ovarian stimulation such as multiples and OHSS are limited with low dose gonadotrophins .