***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 evaluate the efficacy of a 2-month treatment with a gonadotropin-releasing hormone ( GnRH ) agonist prior to in-vitro fertilization in Chinese women with moderate or severe endometriosis . METHODS A study of 162 women surgically diagnosed as having moderate or severe endometriosis . Pituitary down-regulation was achieved with injections of a GnRH agonist prior to the IVF procedures either for 7 to 10 days in the mid-luteal phase ( group 1 [ st and ard protocol ] , 97 cycles in total ) , or for 2 months ( group 2 , 55 cycles ) , or 3 months ( group 3 , 75 cycles ) . RESULTS Women pretreated with a GnRH agonist for 2 or 3 months required significantly higher doses of gonadotropin for ovarian stimulation ( P<0.001 ) , and for a longer time , than those treated with the st and ard long protocol ( P<0.05 ) . The number of oocytes and good embryos was lower in group 3 than in groups 1 or 2 ( P<0.05 ) . The implantation rate was significantly higher in group 2 than in group 1 ( P<0.02 ) . CONCLUSION A 2-month treatment with a GnRH agonist prior to IVF produced a trend toward an increase in the implantation rate in a group of Chinese women with stages III and IV endometriosis Objective : To evaluate the effect of prolonged Gonadotropin releasing hormone ( GnRH ) agonist downregulation in patients with endometriomas of less than 5 cm on the outcome of the proceeding Intracytoplasmic sperm injection ( ICSI ) trial . Methods : In a r and omized controlled trial at a university teaching hospital , 90 patients indicated for ICSI and having unilateral single endometrioma of less than 5 cm in diameter were r and omized into 2 groups . Group A ( 45 patients ) received the st and ard long protocol ; whereas group B ( 45 patients ) received 3 consecutive Intramuscular ( IM ) injections of triptorelin 3.75 mg 28 days apart followed by the st and ard long protocol 28 days after the last injection . Results : There were no significant differences in the clinical and hormonal characteristics between the 2 groups . All ICSI cycle characteristics including number of retrieved oocytes , fertilized oocytes , and transferred embryos were also not significantly different . However , patients who received prolonged GnRH agonist therapy showed significantly higher chemical ( P = .011 ) , clinical ( P = .018 ) , and ongoing ( P = .028 ) pregnancy rates . Conclusion : Prolonged GnRH agonist downregulation improves the pregnancy rates in patients with small endometriomas undergoing ICSI OBJECTIVE To investigate the role of adjuvant treatment with gonadotropin-releasing-hormone agonist ( GnRHa ) following conservative surgical treatment of endometriosis . STUDY DESIGN Sixty patients in the reproductive age ( mean age 28.6 years ) , with symptomatic stages III and IV endometriosis following laparoscopic surgery and without previous hormonal treatment were enrolled in a prospect i ve , r and omized , controlled trial to compare the effects of 3-month treatment with triptorelin depot-3.75 i.m . ( 30 patients ) versus expectant management using placebo injection ( 30 patients ) . RESULTS Six patients ( one in triptorelin group and five in placebo group ) were lost at follow-up , the remaining 54 were suitable for analysis . Pelvic pain persistence or recurrence , endometrioma relapses and pregnancy rate were evaluated during a 5-year follow-up . The results of 29 cases treated with triptorelin and 25 that received placebo did not show significant differences in pain recurrence ( P=1 , RR=0.94 , 95 % CI=0.57 - 1.55 ) , endometrioma relapse ( P=0.67 , RR=1.29 , 95 % CI=0.66 - 2.50 ) , and pregnancy rate in  infertile women  ( P=0.80 , RR=0.81 , 95 % CI=0.37 - 1.80 ) . Curves of time of pain recurrence and pregnancy during 5-year follow-up did not show significant differences between the two groups ( P=0.79 and P=0.51 , respectively , using Mantel-Haenzsel logrank test ) . CONCLUSION Triptorelin treatment after operative laparoscopy for stage III/IV endometriosis does not appear to be superior to expectant management in terms of prevention of symptoms recurrence and endometrioma relapse , and has no influence on pregnancy rate in endometriosis-associated infertility Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post‐operative hormonal therapy  compared with women treated with  surgery  only . Pregnancy rates and time to conception in women wanting children were also evaluated Background . A prospect i ve r and omized study was performed to evaluate the addition of a gonadotropin releasing hormone agonist ( GnRH‐a ) during treatment with human menopausal gonadotropins ( hMG ) in cycles with artificial inseminations with husb and 's washed sperm ( AIH ) . We also compared the pregnancy rate per cycle after one versus two AIHs OBJECTIVE To examine the relationship between endometriosis and pre clinical abortions and to evaluate the effect of gonadotropin-releasing hormone analogue ( GnRH-a ) therapy on these pregnancies . DESIGN AND PATIENTS Of 67 women with severe endometriosis referred to us for in vitro fertilization-embryo transfer ( IVF-ET ) , 32 underwent ovarian stimulation for oocyte retrieval with menotropins ( protocol A ) , whereas the other 35 were admitted for the procedure after a 6-month period of hormonal suppression with a GnRH agonist ( protocol B ) . The clinical impact of the pre clinical and clinical pregnancies in both treatment protocol s were evaluated on the basis of oocyte classification and embryo quality score . SETTING All patients were treated in our IVF Unit . MAIN OUTCOME MEASURE Clinical pregnancy was used as our main outcome measure of success . RESULTS A significantly higher number of pre clinical pregnancies ( P less than 0.0001 ) occurred in patients treated by protocol A. After GnRH-a treatment , the pre clinical pregnancy rate declined significantly ( P less than 0.0001 ) , whereas the clinical pregnancy rate per cycle and per transfer rose significantly ( P less than 0.0001 and P less than 0.0001 , respectively ) . Furthermore , clinical pregnancies had a significantly better mean embryo quality score in comparison with pre clinical pregnancies ( P less than 0.0001 ) . CONCLUSIONS It is concluded that combining GnRH-a therapy before IVF-ET provides an improved treatment modality for pre clinical abortions and infertility associated with severe endometriosis OBJECTIVE The aim of this study was to investigate the impacts of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve , pregnancy outcome and recurrence . MATERIAL S AND METHODS This was a prospect i ve control study . The experimental group : 63 patients with combinations of laparoscopic bilateral ovarian endometrial cystectomies and gonadotropin-releasing hormone agonist ( GnRH-a ) treatment for three months . CONTROL GROUP 62 patients with laparoscopic bilateral ovarian endometrial cystectomies .  Benchmarks : the changes of follicle stimulating hormone ( FSH ) and FSH/luteinizing hormone ( LH ) , etradiol ( E2 ) in preoperative and postoperative three months or menstrual two to three days , menstrual two to three days after surgery , natural pregnancy , and cyst recurrence in 18th month during postoperative follow-up . RESULTS In experimental group after six months , the percentage of returned FSH accounted for 95.3 % of normal range , in the control group it was 82.2 % , and the difference was significant ( p < 0.05 ) . The natural pregnancy rate of preoperative infertility patients ( 57.1 % ) was higher than the control ( 36.8 % ) ( p < 0.05 ) . The recurrence rate of preoperative infertility patients ( 12.7 % ) was lower than the control ( 27.4 % ) ( p < 0.05 ) . CONCLUSION After bilateral laparoscopic ovarian endometrial cystectomy , an implement of GnRH-a therapy can improve the postoperative pregnancy rate , which changes with clinical stage and patient age , reduces ovarian recurrence , and its influence on ovarian reserve is lesser Thirty-six women with ultrasonographic diagnosis of ovarian endometrioma ( bilateral in nine of them ) , have been treated laparoscopically . After the surgical procedure the patients were assigned to one of the following regimes : Gn-RH-a for 3 months , oral contraceptives if they wanted to avoid pregnancy , or nothing . The follow-up consisted in 1 - 3 - 6 - 12 months ultrasound . The first recurrences were observed at the 6-month ultrasound with an overall recurrence rate after 12 months of 11 % . Improvement of pain symptoms occurred in 87 % of the patients and fertility rate was 45 % STUDY QUESTION Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle ? SUMMARY ANSWER Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle . WHAT IS KNOWN ALREADY Endometriosis is a disease known to be related to infertility . However , the influence of superficial endometriosis- and its treatment-is still a matter of debate . STUDY DESIGN , SIZE , DURATION A prospect i ve controlled , r and omized , open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured . Patients with laparoscopically diagnosed peritoneal endometriosis ( n= 120 ) were treated by laser surgery after which they were sequentially r and omized by computer-generated allocation to one of the two groups . The primary outcome of the trial was the number of Metaphase II ( MII ) oocytes . Sample size was chosen to detect a difference of two MII oocytes with a power of 80 % . The control group ( Group B ) received the classical long protocol IVF stimulation , whereas the research group ( Group A ) had an additional pituitary suppression , of 3 months using a long-acting GnRH agonist , prior to IVF . PARTICIPANTS / MATERIAL S , SETTING , METHODS A total of 120 patients were included in the study , 61 of them in the study group and 59 patients in the control group . One patient of the control group was lost to follow up leading to 58 evaluable patients . MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in terms of the number of MII oocytes obtained per cycle : 8.2 in both groups ( difference in MII between A and B : 0.07 [ -1.89 ; 2.04 ] 95 % confidence interval ( CI ) ) . Pregnancy rate did not differ , being 39.3 % for Group A ( 24 out of 61 patients ) versus 39.7 % for Group B ( 23 out of 58 patients ) ( 95 % CI around difference in pregnancy rate between A and B : -0.31 % [ -17.96 % ; 17.86 % ] ) . However , a significantly ( P = 0.025 ) lower dose of FSH ( 2561 IU for Group A and 2303 IU for Group B , 95 % CI around difference in FSH between B and A : -258.6 IU [ -483.4 IU ; -33.8 IU ] ) and a significantly ( P = 0.004 ) shorter stimulation period ( Group A 12.3 days and Group B 11.3 days , 95 % CI around difference in stimulation period between B and A : -1.03 days [ -1.73 days ; -0.33 days ] ) were needed to reach adequate follicle maturation in the control group . LIMITATIONS , REASON FOR CAUTION The validity of this study is limited to mild peritoneal endometriosis , and does not apply to ovarian endometriosis , which is also commonly seen in infertility patients . WIDER IMPLICATION S OF THE FINDINGS There is no indication for complementary medical treatment of peritoneal endometriosis in terms of IVF outcome . On the contrary , stimulation takes longer and requires a higher amount of medication . STUDY FUNDING /COMPETING INTERESTS There was no external funding for this clinical trial in the IVF Center , AZ Jan Palfijn , Ghent . There are no competing interests to declare . TRIAL REGISTRATION NUMBER EudraCT nr : 2012 - 000784 - 25 . TRIAL REGISTRATION DATE First registration on 29 February 2012 and re-entered on 23 August 2012 , 
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Contrary to previous findings , we are uncertain as to whether long-term GnRH agonist therapy impacts on the live birth rate or indeed the complication rate compared to st and ard IVF/ICSI .
Further , we are uncertain whether this intervention impacts on the clinical pregnancy rate , multiple pregnancy rate , miscarriage rate , mean number of oocytes and mean number of embryos .