***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 Retrospective studies suggest that laparoscopic excision of endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation . In this study , we prospect ively evaluated ovarian response to hyperstimulation in women selected for in vitro fertilization and intracytoplasmic sperm injection cycles who previously underwent laparoscopic enucleation of a monolateral endometrioma . STUDY DESIGN Operated and contralateral intact  ovaries of the same patient were compared in terms of number of follicles , number of oocytes retrieved , fertilization rate , and rate of high- quality embryos . RESULTS Thirty-eight subjects were included . A reduced number of dominant follicles , oocytes , embryos , and high- quality embryos was observed in the operated gonad . The mean percentage of reduction was 60 % ( 95 % confidence interval 38 - 81 % ) , 53 % ( 95 % confidence interval 30 - 75 % ) , 55 % ( 95 % confidence interval 28 - 81 % ) , and 52 % ( 95 % confidence interval 17 - 87 % ) , respectively . Fertilization rate and rate of good- quality embryos were similar . CONCLUSION Laparoscopic excision of endometriomas is associated with a quantitative but not a qualitative damage to ovarian reserve OBJECTIVE To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation ( COH ) improves intracytoplasmic sperm injection ( ICSI ) outcomes . DESIGN Prospect i ve study . SETTING University hospital . PATIENT(S ) A prospect i ve analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups : aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery ( n = 41 ) ( group 1 ) ; nonaspirated endometriomas ( n = 40 ) ( group 2 ) ;  history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH ( n = 44 ) ( group 3 ) ; and  tubal factor infertility ( n = 46 ) ( control group 4 ) . INTERVENTION(S ) Aspiration of endometriomas . MAIN OUTCOME MEASURE(S ) Clinical parameters , characteristics of COH , and ICSI results were analyzed . RESULT ( S ) We observed higher levels of E(2 ) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas . When we compared all endometriomas and tubal factor ( control ) groups , we observed a lower number of total follicles ( > 17 mm ) and metaphase II ( MII ) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group . Implantation and clinical pregnancy rates were similar among all groups . CONCLUSION ( S ) In the current study , all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility . We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles > 17 mm , the number of MII oocytes retrieved , the implantation rates , or the clinical pregnancy rates . Resection of small endometriomas ( 1 - 6 cm ) may not present any additional benefits to the IVF-ICSI cycle outcomes OBJECTIVE To determine whether the stripping technique by laparoscopy is a tissue-sparing procedure . DESIGN Prospect i ve study . SETTING University hospital . PATIENT(S ) Forty-two women , 21 to 35 years of age , who had a unilateral ovarian cyst ( 26 endometriomas , 7 serous , 6 dermoid , and 3 mucinous cysts ) . INTERVENTION(S ) Laparoscopic excision of ovarian cysts by using the stripping technique . MAIN OUTCOME MEASURE(S ) Histologic analysis of the excised specimens was done to evaluate the presence and nature of ovarian tissue adjacent to the cyst wall . RESULT ( S ) Recognizable ovarian tissue adjacent to the cyst wall was present in 15 of 42 excised specimens ( 36 % ) . A significant difference was present for endometriomas versus non-endometriosis cysts ( ovarian tissue was present in 14 of 26 specimens [ 54 % ] vs. 1 of 16 specimens [ 6 % ] ; P<.005 ) . No specimen showed the normal follicular pattern observed in healthy ovaries . CONCLUSION ( S ) The stripping technique appears to be a tissue-sparing procedure . In 36 % of the cysts , ovarian tissue is excised together with the cyst wall , but this tissue does not show the morphologic characteristics observed in normal ovarian tissue Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated , but a study of the natural history of endometriosis has demonstrated that 47 % ( 95 % confidence limits , 23–71 % ) of patients ( n=35 ) given  placebo in a double‐blind , r and omized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy . The active agent , the progestogen gestrinone , was given at a dose of 2.5 mg twice weekly and result ed in an improvement of the disease ( p < 0.004 ) . Furthermore , follow‐up over 12 months showed no significant difference between those patients treated with active agent or placebo , and none between those with persistent disease and those in whom it had been obliterated . These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease , but that the treatment does not influence subsequent fertility . They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement , active treatment should be instituted , and that the new gestogen , gestrinone is efficacious . Other treatments , such as  danazol or luteinizing hormone releasing hormone ( LHRH ) agonists , or the older contraceptive or pseudopregnancy regimens , must be set against spontaneous improvement ( in 5 of 17 patients i.e. 29 % ) or elimination ( in 4 of 17 patients i.e. 24 % ) in the placebo group . Infertile patients with mild endometriosis  have disorders of follicular and luteal function , and in vitro fertilization suggests a reduced fertilization rate . Nevertheless , these patients require active treatment if these problems are not to be compounded by adhesions , possibly leading to ovarian enclosure , that would further reduce the untreated cumulative conception rate 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 In the first of two studies , 20 patients were selected on the basis of tubal infertility and were r and omly assigned to two groups receiving different ovarian stimulation protocol s. In group A , 10 patients were given follicle-stimulating hormone ( FSH ) , FSH was continued until the criteria for human chorionic gonadotropin ( hCG ) administration were satisfied . In group B , 10 patients received Buserelin ( 0.3 ml twice a day subcutaneously ) for 14 days to induce pituitary desensitization . Stimulation with FSH was then started , and Buserelin treatment was continued until hCG administration . In the second study , patients were included if they had had at least two previous attempts at ovarian stimulation that failed to reach the stage of follicular aspiration . Ovarian stimulation was conducted with a combination of Buserelin and human menopausal gonadotropin . Use of the gonadotropin-releasing hormone ( GnRH ) agonist in in vitro fertilization increased the number of oocytes collected , the fertilization rate , the length of the luteal phase and the pregnancy rate . The GnRH agonist also contributed to a generally better ovarian response in patients whose estradiol production had previously responded poorly to conventional ovarian stimulation protocol OBJECTIVE To investigate the outcomes of intracytoplasmic sperm injection ( ICSI ) cycles after controlled ovarian hyperstimulation ( COH ) with GnRH antagonist or GnRH agonist ( GnRH-a ) in mild-to-moderate endometriosis and endometrioma . DESIGN Prospect i ve r and omize trial . SETTING A private IVF center . PATIENT(S ) A total of 246 ICSI cycles in 246 patients were divided into three groups : women with mild-to-moderate endometriosis ( n = 98 ) ; women who had ovarian surgery for endometrioma ( n = 81 ) ; women with endometrioma and no history of previous surgery ( n = 67 ) . INTERVENTION(S ) Patients in each group were r and omized to COH with either triptrolein or cetrorelix . MAIN OUTCOME MEASURE(S ) Clinical parameters , characteristics of COH , and ICSI results were analyzed . RESULT ( S ) Outcomes of COH with both GnRH antagonist and GnRH-a were similar in patients with mild-to-moderate endometriosis .  Implantation rates were 15.9 % vs. 22.6 % and clinical pregnancy rates were 27.5 % vs. 39 % with GnRH antagonist and GnRH-a protocol s , respectively , in patients who had ovarian surgery for endometrioma .  Implantation rates were 12.5 % vs. 14.8 % and clinical pregnancy rates were 20.5 % vs. 24.2 % with GnRH antagonist and GnRH-a protocol s , respectively , in patients with endometrioma and no history of ovarian surgery . CONCLUSION ( S ) Considering the implantation and clinical pregnancy rates , COH with both GnRH antagonist and GnRH-a protocol s may be equally effective in patients with mild-to-moderate endometriosis and endometrioma who did and did not undergo ovarian surgery The study was conducted to investigate the effect of conservative surgery of ovarian endometriomas before an ICSI cycle . Ninety-nine patients with endometriomas who were referred to an intracytoplasmic sperm injection ( ICSI ) cycle were enrolled in the study . The patients were prospect ively r and omized into two groups ; group I ( 49 patients ) underwent conservative ovarian surgery before the ICSI cycle and group II ( 50 patients ) underwent the ICSI cycle directly . The stimulation was started 3 months after the operation in group I and directly in group II . In the ovarian surgery group , stimulation was significantly longer ( 14.0 days in group I and 10.8 days in group II ; P = 0.001 ) , total recombinant FSH dose was significantly higher ( 4575 IU in group I and 3675 IU in group II ; P = 0.001 ) , and mean number of mature oocytes was significantly lower ( 7.8 in group I and 8.6 in group II ; P = 0.032 ) . There was no difference in terms of fertilization ( 86 % in group I and 88 % in group II ) , implantation ( 16.5 % in group I and 18.5 % in group II ) and pregnancy rates ( 34 % in group I and 38 % in group II ) . Ovarian surgery result ed in longer stimulation , higher FSH requirement and lower oocyte number , but fertilization , pregnancy and implantation rates did not differ between the groups OBJECTIVE To describe the characteristics of the  endometrial  cyst and to locate the implants for selective biopsy . DESIGN Prospect i ve study . SUBJECTS Fifty-one women with one or two ovarian chocolate cysts of 3 cm or more were investigated . INTERVENTIONS Laparoscopy and r and om biopsy versus a new technique of ovarioscopy and selective biopsy . MAIN OUTCO 
    Output:
    
There was no evidence of an effect on reproductive outcomes in any of the four included trials .