***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 
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    Input: Purpose To study whether intravaginal application of seminal plasma after follicle aspiration has the potential to increase implantation and clinical pregnancy rates after IVF-ET . Methods We conducted a prospect i ve , double-blind , placebo-controlled r and omized study of 230 patients undergoing IVF-ET cycles .  500 μL of Fresh seminal plasma from the patient ’s partner or culture medium ( placebo ) were injected in the vaginal vault just after follicle aspiration . The main outcome measured was ongoing clinical -pregnancy rate . Results After ET cancellation in ten patients due to lack of fertilization or embryo cleavage , 220 embryo transfers ( 103 and 117 in the study and control groups ) result ed in a clinical pregnancy rate of 36.9 % and 29.1 % for the study and control groups , corresponding to a relative increase of 26.8 % . After an early pregnancy loss of 13.1 % ( 5/38 ) and 23.5 % ( 8/34 ) in the study and control groups respectively an ongoing pregnancy rate of 32.0 % ( 33/103 ) and 22.2 % ( 26/117 ) was achieved corresponding to a relative increase of 44.1 % . Multivariate logistic regression analysis adjusted for study group , age , infertility , and cycle characteristics did not demonstrate any parameter that could predict occurrence of clinical pregnancy rates after IVF-ET . Conclusions Patients who underwent SP intravaginal insemination after oocyte pick-up reached higher implantation and clinical pregnancy rates following ET compared to controls , although the difference did not reach statistical significance . More studies and variable method ologies may clarify the potential clinical effect of SP in improving live birth rates after ART Intercourse during an IVF cycle has the potential to improve pregnancy rates since exposure to semen is reported to promote embryo development and implantation in animals . Conversely , coitus-induced uterine contractions or introduction of infection may have a detrimental effect . A multicentre prospect i ve r and omized control trial was conducted to determine if intercourse during the peri-transfer period of an IVF cycle has any influence on pregnancy success .  Participants undergoing thawed embryo transfer ( Australian centre ) or fresh embryo transfers ( Spanish centres ) were r and omized either to abstain or to engage in vaginal intercourse around the time of embryo transfer . The transfer of 1343 embryos during 478 cycles of IVF result ed in 107 pregnancies ( 22.4 % ) , with 125 viable embryos remaining by 6 - 8 weeks gestation . There was no significant difference between the intercourse and abstain groups in relation to the pregnancy rate ( 23.6 and 21.2 % respectively ) , but the proportion of transferred embryos that were viable at 6 - 8 weeks was significantly higher in women exposed to semen compared to those who abstained ( 11.01 versus 7.69 viable embryos per 100 transferred embryos , P = 0.036 , odds ratio 1.48 , 95 % confidence interval 1.01 - 2.19 ) . Hence exposure to semen around the time of embryo transfer increases the likelihood of successful early embryo implantation and development OBJECTIVE To evaluate whether intravaginal application of seminal plasma at the time of follicle aspiration in IVF or intracytoplasmic sperm injection treatment cycles has the potential to increase pregnancy rate . To calculate the number of patients needed to achieve significance in a multicenter trial . DESIGN Double-blind , placebo-controlled r and omized pilot study . SETTING University department of gynecological endocrinology and reproductive medicine . PATIENT(S ) One hundred sixty-eight patients undergoing IVF or intracytoplasmic sperm injection treatment .  INTERVENTION(S ) Cryopreserved seminal plasma from the patient 's partner or sodium chloride ( placebo ) was injected into the cervix and the posterior fornix of the vagina just after follicle aspiration . MAIN OUTCOME MEASURE(S ) Clinical -pregnancy rate . RESULT ( S ) One hundred sixty-eight patients agreed to participate in the study . Participation was limited to one treatment cycle . Thirty-one patients ( 18 % ) were excluded from the study , mainly as a result of canceled embryo transfers . Seventy patients received  placebo , and 67 received seminal plasma . The clinical -pregnancy rate was 25.7 % ( 18/70 ) in the placebo group . The clinical -pregnancy rate in the seminal plasma group reached 37.3 % ( 25/67 ) , corresponding to a relative increase of 45 % . CONCLUSION ( S ) Even though significance was not reached in this pilot study , the data suggest that seminal plasma has the potential to improve pregnancy rate . It is estimated that around 450 patients need to be recruited to reach significance in a multicenter study OBJECTIVE To investigate the effect of intracervical and intravaginal application of seminal plasma on the endometrium , as assessed by endometrial/subendometrial vascularization and endometrial volume between the day of oocyte retrieval and the day of embryo transfer in an in-vitro fertilization/intracytoplasmic sperm injection ( IVF/ICSI ) cycle . METHODS This was a double-blind , placebo-controlled , r and omized study including patients undergoing a first or second IVF/ICSI cycle .  Homologous seminal plasma or placebo ( sodium chloride ) was injected into the cervix and posterior vaginal fornix just after follicle aspiration . Three-dimensional power Doppler examination was performed 30 min before oocyte retrieval and 30 min before embryo transfer . Main outcome measures were changes in vascularization flow index ( VFI ) , flow index ( FI ) and vascularization index ( VI ) of the endometrium/subendometrium using VOCAL ™ ( Virtual Organ Computer-aided AnaLysis ) and endometrial volume . RESULTS One hundred patients agreed to participate in the study . Twenty-three patients were excluded , mainly as a result of canceled embryo transfer . Data were analyzed from 40 patients receiving seminal plasma and 37 receiving placebo . No significant differences between the two groups were seen in VFI , FI or VI of the endometrium or subendometrium or in endometrial volume on the day of oocyte pick-up and on the day of embryo transfer . CONCLUSION Neither endometrial/subendometrial vascularization parameters nor endometrial volume seem to be affected by the application of seminal plasma in patients undergoing their first or second IVF/ICSI cycle Purpose In IVF procedures , endometrial function is a limiting factor of the pregnancy rate and the aims of this study is to determine whether seminal plasma insemination at ovum pick-up in IVF has any effect on pregnancy rate . Methods We design ed a single center , 2 parallel groups , r and omized pilot study . All couples undergoing an IVF procedure in our clinic between January 2010 and December 2011 were considered for enrollment in the study . The patients who met the inclusion criteria were r and omized into two groups by simple r and omization : the seminal plasma group ( SP group ) and the reference group ( noSP group ) . We applied seminal plasma into the cervix and vaginal vault at the time of the OPU in the patients of the SP group . The primary outcome was the clinical pregnancy rate in the SP group compared with the noSP group and the secondary outcome measure was the implantation rate . Results 400 patients met the inclusion criteria and were r and omized . 54 patients were excluded from the study mainly because they did n’t undergo the embryo transfer . Finally , 164 patients were included in the SP group and 182 patients in the noSP group and analyzed . We found a statistically non-significant increase in the pregnancy rate in the SP group ( 55.5 % versus 44 % , p = 0.09 ) and a statistically significant increase in the implantation rate ( 34.7 % versus 27.5 % , p = 0.026 ) . Conclusions Our results support the idea that SP insemination may have the potential to increase pregnancy rate in IVF procedures but further studies must be carried out STUDY QUESTION Does intrauterine application of diluted seminal plasma ( SP ) at the time of ovum pick-up improve the pregnancy rate by ≥14 % in IVF treatment ? SUMMARY ANSWER Intrauterine instillation of diluted SP at the time of ovum pick-up is unlikely to increase the pregnancy rate by ≥14 % in IVF . WHAT IS KNOWN ALREADY SP modulates endometrial function , and sexual intercourse around the time of embryo transfer has been suggested to increase the likelihood of pregnancy . A previous r and omized double-blind pilot study demonstrated a strong trend towards increased pregnancy rates following the intracervical application of undiluted SP . As this study was not conclusive and as the finding could have been confounded by sexual intercourse , the intrauterine application of diluted SP was investigated in the present trial . STUDY DESIGN , SIZE , DURATION A single-centre , prospect i ve , double-blind , placebo-controlled , r and omized , superiority trial on women undergoing IVF was conducted from April 2007 until February 2012 at the University Department of Gynaecological Endocrinology and Reproductive Medicine , Heidelberg , Germany . PARTICIPANTS / MATERIAL S , SETTING , METHODS The study was powered to detect an 14 % increase in the clinical pregnancy rate and two sequential tests were planned using the Pocock spending function . At the first interim analysis , 279 women had been r and omly assigned to intrauterine diluted SP ( 20 % SP in saline from the patients ' partner ) ( n = 138 ) or placebo ( n = 141 ) at the time of ovum pick-up . MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate per r and omized patient was 37/138 ( 26.8 % ) in the SP group and 41/141 ( 29.1 % ) in the placebo group ( difference : -2.3 % , 95 % confidence interval of the difference : -12.7 to + 8.2 % ; P = 0.69 ) . The live birth rate per r and omized patient was 28/138 ( 20.3 % ) in the SP group and 33/141 ( 23.4 % ) in the placebo group ( difference : -3.1 % , 95 % confidence interval of the difference : -12.7 to + 6.6 % ; P = 0.56 ) . It was decided to terminate the trial due to futility at the first interim analysis , at a conditional power of 62 % . LIMITATIONS , REASONS FOR CAUTION The confidence interval of the difference remains wide , thus clinical ly relevant differences can not reliably be excluded based on this single study . WIDER IMPLICATION S OF THE FINDINGS The results of this study cast doubt on the validity of the concept that SP increases endometrial receptivity and thus implantation in humans . STUDY FUNDING /COMPETING INTEREST(S ) Funding was provided by the department 's own research facilities . TRIAL REGISTRATION NUMBER DRKS00004615 
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There was low quality evidence suggesting little or no difference between the groups in rates of live birth or ongoing pregnancy ( composite outcome ) .
We found low quality evidence that seminal plasma application may be associated with more clinical pregnancies than st and ard ART .
There was low quality evidence suggesting little or no difference between the groups in rates of multiple pregnancy .
There was insufficient evidence to reach any conclusions about the risk of ectopic pregnancy , and no data were available on infectious complications or other adverse events .