***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 Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies , result ing in high costs . We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF . METHODS Four hundred and four patients were r and omly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer , or st and ard stimulation/GnRH agonist long protocol and the transfer of two embryos . The main outcome measures are total costs of treatment within a 12 months period after r and omization , and the relationship between total costs and proportion of cumulative pregnancies result ing in term live birth within 1 year of r and omization . RESULTS Despite a significantly increased average number of IVF cycles ( 2.3 versus 1.7 ; P < 0.001 ) , lower average total costs over a 12-month period ( 8333 versus euro10 745 ; P = 0.006 ) were observed using the mild strategy . This was mainly due to higher costs of the obstetric and post-natal period for the st and ard strategy , related to multiple pregnancies . The costs per pregnancy leading to term live birth were euro19 156 in the mild strategy and euro24 038 in the st and ard . The incremental cost-effectiveness ratio of the st and ard strategy compared with the mild strategy was euro185 000 per extra pregnancy leading to term live birth . CONCLUSIONS Despite an increased mean number of IVF cycles within 1 year , from an economic perspective , the mild treatment strategy is more advantageous per term live birth . It is unlikely , over a wide range of society 's willingness-to-pay , that the st and ard treatment strategy is cost-effective , compared with the mild strategy BACKGROUND Anti-Müllerian hormone ( AMH ) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum . Since the number of ovarian follicles declines with increasing age , AMH levels might be used as a marker for ovarian ageing . Therefore , we studied the relationship between AMH levels and ovarian response during ovarian stimulation for IVF . METHODS A total of 130 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospect ively included .  Blood withdrawal was performed and the number of antral follicles was assessed by ultrasound on day 3 of a spontaneous cycle . Poor response and the number of oocytes were used as primary outcome measures . In a r and om subset of 23 patients a GnRH agonist stimulation test was performed to investigate whether a rise in FSH and LH would affect AMH levels . RESULTS The data of 119 patients were analysed .  Serum AMH levels were highly correlated with the number of antral follicles ( r = 0.77 ; P < 0.01 ) and the number of oocytes retrieved ( r = 0.57 , P < 0.01 ) . A negative association was found between AMH levels and poor ovarian response ( fewer than 4 oocytes or cycle cancellation ; OR 0.82 , 95 % CI 0.75 - 0.90 , P < 0.01 ) . Inclusion of inhibin B and FSH concentrations to AMH in a multivariate model improved the prediction of ovarian response . The post GnRH agonist rise in FSH and LH levels did not influence AMH values . CONCLUSIONS Poor response in IVF , indicative of a diminished ovarian reserve , is associated with reduced baseline serum AMH concentrations . In line with recent observations it appears that AMH can be used as a marker for ovarian ageing OBJECTIVE To compare fixed daily doses of the recombinant FSH ( rFSH ) Gonal-F ( 150 IU vs. 225 IU ) for ovarian stimulation in IVF-ET . DESIGN Single-center prospect i ve , r and omized study . Assisted conception unit of a university hospital . One hundred twenty-four women aged 23 - 41 years participated in the study . Exclusion criteria were as follows : FSH of > 10 IU/L , polycystic ovarian syndrome , one ovary or previous ovarian surgery , previous poor response to ovarian stimulation , or ovarian hyperstimulation syndrome ( OHSS ) . INTERVENTION(S ) R and omized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment . MAIN OUTCOME MEASURE(S ) Number of oocytes retrieved and total rFSH dose . RESULT ( S ) More oocytes were retrieved in women aged < or=32 years in the 225-IU compared with the 150-IU group ( 11.8 + /- 8.0 vs. 7.0 + /- 5.8 ) . In older women ( > or=33 years ) , the number of oocytes retrieved in the two groups were similar . No significant differences were found for fertilization rate , number of embryos formed and cryopreserved , and pregnancy rates between the two groups . The total rFSH dose used was higher in the 225-IU group ( 2,595.0 + /- 510.0 vs. 1,897.5 + /- 457.5 IU ) . The cancellation rate due to insufficient ovarian response was higher in the 150-IU group ( 15.0 % vs. 3.3 % ) . All cases of ovarian hyperstimulation syndrome ( n = 4 ) occurred in the 225-IU group . CONCLUSION ( S ) Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield , suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation BACKGROUND Individualization of controlled ovarian stimulation ( COS ) for assisted conception is complicated by variable ovarian response to follicle stimulating hormone . We hypothesized that anti-Müllerian hormone ( AMH ) , a predictor of oocyte yield , may facilitate treatment strategies for women undergoing COS  , to optimize safety and clinical pregnancy rates . METHODS Prospect i ve cohort study of 538 patients in two centres with differential COS strategies based on a central ized AMH measurement . RESULTS AMH was associated with oocyte yield after ovarian stimulation in both centres , and a ' reduced ' AMH ( 1 to < 5 pmol/l ) was associated with a reduced clinical pregnancy rate .  Women with a ' normal ' AMH ( 5 to < 15 pmol/l ) treated with a  long GnRH-agonist protocol  ( both centres ) showed a low incidence of excess response ( 0 % ) and poor response ( 0 % ) . In women with ' high ' AMH ( > 15 pmol/l ) , the antagonist protocol eliminated the need for complete cryopreservation of embryos due to excess response ( P < 0.001 ) and showed a higher fresh cycle clinical pregnancy rate than agonist cycles [ OR 4.40 ( 95 % CI 1.95 - 9.93 ) , P < 0.001 ] . CONCLUSIONS The use of circulating AMH to individualize treatment strategies for COS may result in reduced clinical risk , optimized treatment burden and maintained pregnancy rates , and is worthy of prospect i ve r and omized examination Purpose : To study the value of a single or repeated GnRH agonist stimulation test ( GAST ) in predicting outcome in IVF compared to basal ovarian reserve tests . Methods : A total of 57 women was included . In a cycle prior to the IVF treatment , on day 3 , an antral follicle count ( AFC ) was performed and blood taken for basal FSH , inhibin B and E2 measurements , followed by a subcutaneous injection of 100 μg triptorelin for the purpose of the GAST . Twenty-four hours later blood sampling was repeated . All the tests were repeated in a subsequent cycle . From the GAST E2 and inhibin B response were used as test parameters . The outcome measures were poor ovarian response and ongoing pregnancy . Group comparisons were done using the Mann– Whitney or chi-square test . Univariate and multivariate logistic regression was applied to assess which test revealed the highest predictive accuracy as expressed in the area under receiver-operating characteristic curve ( ROCAUC ) . Clinical value was compared by calculating classical test characteristics for the best logistic models . Results : All the basal and GAST variables were significantly different in the poor responders ( n = 19 ) compared to normal responders ( n = 38 ) . In the univariate analysis on cycle 1 tests the AFC was the best predictor for poor ovarian response , while in cycle 2 the E2 response in the GAST performed best ( ROCAUC of 0.91 for both ) . Multivariate analysis of the basal variables led to the selection of AFC and inhibin B in cycle 1 , yielding a ROCAUC of 0.96 . Mean E2 response was selected in a multivariate analysis of the repeated GAST variables ( ROCAUC 0.91 ) . At a specificity level of ∼0.90 , several logistic models including GAST variables appeared to have a sensitivity ( ∼0.80 ) , positive predictive value ( ∼0.82 ) and false positive rate ( ∼0.18 ) , comparable to a logistic model containing AFC and inhibin B. None of the test variables showed a significant relation with ongoing pregnancy . Conclusions : The GAST has a rather good ability to predict poor response in IVF . However , comparing the predictive accuracy and clinical value of the GAST with a day 3 AFC and inhibin B , it appeared that neither a single nor a repeated GAST performed better . In addition , the predictive ability towards ongoing pregnancy is poor . Therefore , the use of the GAST as a predictor of outcome in IVF should not be advocated Predicting ovarian response to stimulation constitutes a pivotal task in the organization of a successful in-vitro fertilization ( IVF ) programme . The purpose of the current study was to determine whether a new ovarian reserve test , the exogenous follicle stimulating hormone ovarian reserve test ( EFORT ) , could improve the predictive value of the classical follicle stimulating hormone ( FSH ) measurements on cycle day 3 of ovarian stimulation regarding results of IVF . In this prospect i ve study , 52 IVF c and i date s aged 27 - 42 years underwent 52 consecutive IVF cycles . These women received 300 IU of purified FSH i.m . on cycle day 3 . Blood sample s were taken just before the injection to measure plasma FSH and oestradiol ; 24 h later , plasma oestradiol concentration was determined . Two menstrual cycles later , ovarian stimulation was performed for IVF using a time-release gonadotrophin-releasing hormone agonist ( GnRHa ) and human menopausal gonadotrophin ( HMG ) . For the interpretation of the EFORT results , we considered the post-FSH plasma oestradiol increment ( delta E2 ) and the baseline plasma FSH values ( bFSH ) . The results of these two parameters were compared with the subsequent quality of the ovarian response to stimulation for IVF and the pregnancy outcome . Our results indicated a statistically significant improvement of the predictive value of the bFSH on the ovarian stimulation outcome when the EFORT parameters ( bFSH and delta E2 ) were analysed synergistically . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND There is scanty information analysing the predictive value of a poor response , in terms of cancellation of the IVF cycle because of poor follicular development , as a predictor of ovarian response in a subsequent treatment cycle . This study , where logistic regression analysis was used , was undertaken to investigate the relative power of the woman 's age , basal FSH , and previous cycle cancellation both as single and combined predictors of ovarian response in an IVF program where pituitary desensitization is routinely used . METHODS One hundred and twenty-nine consecutive patients having their first cycle of IVF/ICSI treatment cancelled because of poor follicular response and undergoing a second attempt within 6 months after the failed treatment cycle were initially selected ( group 1 ) . Group 2 comprised 129 patients undergoing the first cycle of IVF/ICSI treatment and who were r and omly selected from our assisted reproductive treatment program matching by BMI and indication for IVF/ICSI to those in group 1 . RESULTS Cancellation rate was significantly higher but ovarian response significantly lower in group 1 as compared with group 2 . As indicated by the AUC(ROC ) determined with ROC analysis , such a poor outcome in patients having a previous IVF/ICSI cycle cancelled due to poor response was observed whatever the level of basal FSH . In a logistic regression analysis and according to the odds ratio values , the predictive capacity of a previous poor response was 9 and 7.6 times higher than the predictive capacity of age and basal FSH , respectively . Any two or all three variables studied did not improve the predictive value of previous cycle cancellation alone . CONCLUSIONS The history of an IVF/ICSI cancelled cycle due to poor follicular response in a st and ard stimulation protocol is a better predictor of cancellation in subsequent treatment cycles than age or FSH . The poor ovarian response associated with previous cycle cancellation occurs whatever the level of basal FSH AIMS To characterize the pharmacokinetics of recombinant-human follicle stimulating hormone ( r-hFSH ) and urinary-human follicle stimulating hormone ( u-hFSH ) using population pharmacokinetic analysis and deconvolution techniques . METHODS Sparse data were available from  
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This cl aim seems to be truer for poor response prediction , compared to hyper response .
Prediction of the outcome pregnancy has repeatedly shown to be cumbersome .
A first cycle poor response to adequate stimulation in cases with otherwise no signs of advanced ovarian ageing ( based on female-- age and ovarian reserve tests ) may offer a tool to identify cases with sufficient prospect s for continuation of ART treatment--