***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: OBJECTIVE To assess the effectiveness of controlled ovarian hyperstimulation ( COH ) in intrauterine insemination ( IUI ) for subfertile couples with an abnormal postcoital test and a poor prognosis . DESIGN R and omized clinical trial . SETTING Twenty-four fertility centers in the Netherl and s. PATIENT(S ) Subfertile couples with a well-timed nonprogressive PCT and additional factors that reduce fertility . INTERVENTION(S ) Couples were r and omly allocated to three cycles of IUI with COH or three cycles of IUI without COH . MAIN OUTCOME MEASURE(S ) Ongoing pregnancy within three IUI cycles . RESULT ( S ) We r and omly allocated 132 couples to IUI with COH , and 133 , to IUI without COH . We observed 33 pregnancies ( 25 % ) in the couples allocated to IUI with COH , of which 28 were ongoing ( 21 % ) , vs. 28 pregnancies ( 21 % ) in the couples allocated to IUI without COH , of which 23 were ongoing ( 17 % ; relative risk of an ongoing pregnancy , 1.2 ; 95 % confidence interval , 0.75 to 2.0 ) . Two multiple pregnancies occurred in the IUI with COH group , and one , in the IUI without COH group . CONCLUSION ( S ) In couples with an abnormal PCT and a poor prognosis , IUI with COH leads to pregnancy rates comparable to those for IUI without COH . We propose to perform IUI without COH in couples with an abnormal PCT A prospect i ve r and omized study was conducted in 47 couples with infertility due to subnormal semen to compare luteinizing hormone (LH)-timed intrauterine insemination with LH-timed natural intercourse . No pregnancy occurred in 114 cycles of intrauterine insemination with washed sperm . Only one patient conceived during 1 of the 124 natural intercourse cycles . The only complication that occurred after intrauterine insemination was mild abdominal cramp in 3 cycles . The authors conclude that intrauterine insemination is not useful in the management of subfertility due to oligoasthenospermia After r and omization of subfertile couples with an isolated cervical factor to intrauterine insemination for 6 months or expectant management for 6 months , 26 women ( 51 % ) vs. 16 women ( 33 % ) conceived , respectively . Of these pregnancies , 22 ( 43 % ) vs. 13 ( 27 % ) were ongoing ( relative risk , 1.6 ; 95 % confidence interval , 0.91 to 2.8 ) . There was one multiple pregnancy in the group that was allocated to intrauterine insemination . This trial suggests a beneficial effect of IUI in couples with an isolated cervical factor The aim of this prospect i ve r and omized controlled study was to determine the possible role of ovulation induction with intrauterine insemination ( IUI ) in the treatment of  unexplained infertility .  A total of 100 patients were r and omized to receive ovulation induction with or without IUI . All patients were treated with long-course gonadotrophin-releasing hormone analogue ( GnRHa ) , starting in the luteal phase , and exogenous follicle stimulating hormone ( FSH ) to induce follicular growth . Ovulation was induced using human chorionic gonadotrophin and timed intercourse ( TI ) was advised 24 - 48 h later or IUI was effected 36 - 48 h later . Both the cycle fecundities ( 21.8 and 8.5 % ) and the cumulative ongoing pregnancy rates after three cycles ( 42 and 20 % ) were significantly higher ( P < 0.03 ) in the IUI group than in the TI group respectively . This is a clear indication that ovulation induction with  IUI  is an effective treatment method for unexplained infertility , but ovulation induction with TI has a negligible impact in this large group of patients Efficacy of intrauterine insemination ( IUI ) using washed spermatozoa for treatment of oligozoospermia was evaluated by a prospect i ve r and omized study in 50 couples , using LH-timed natural intercourse in the alternate menstrual cycles as a control . The quality of spermatozoa in terms of their concentration and motility before and after sperm washing was compared . Sperm motility increased significantly after sperm preparation but the number of sperm was reduced . Eight pregnancies occurred in 253 cycles of IUI with washed spermatozoa and clomiphene citrate-stimulated cycles ( 3.16 % per cycle ) . Only one patient conceived in 242 LH-timed natural intercourse cycles ( 0.41 % per cycle ) . Compared with LH-timed natural intercourse , IUI provided a significantly improved pregnancy rate . When the sperm count was < 5 x 10(6 ) per ml , no pregnancy occurred with the IUI method . Therefore , IUI is a of rather limited usefulness when the sperm quality is very poor . Few complications occurred after IUI , but included slight cervical contact bleeding and mild abdominal discomfort and /or cramps . In conclusion , IUI should be considered as a useful and relatively non-invasive therapeutic modality for treating caused by moderate oligozoospermia ( > 5 x 10(6)/ml ) , when sexual intercourse fails BACKGROUND Intrauterine insemination with controlled ovarian hyperstimulation is commonly used as first-line treatment for couples with unexplained subfertility .  Since such treatment increases the risk of multiple pregnancy , a couple 's chances of achieving an ongoing pregnancy without it should be considered to identify those most likely to benefit from treatment . We aim ed to assess the incremental effectiveness of intrauterine insemination with controlled ovarian hyperstimulation compared with expectant management in couples with unexplained subfertility  and an intermediate prognosis of a spontaneous ongoing pregnancy . METHODS 253 couples with unexplained subfertility and a 30 - 40 % probability of a spontaneous ongoing pregnancy within 12 months were r and omly assigned either intrauterine insemination with controlled ovarian hyperstimulation for 6 months or expectant management for 6 months . The primary endpoint of this hospital-based study was ongoing pregnancy within 6 months . Analysis was by intention to treat . This trial is registered with the Dutch Trial Register and as an International St and ard R and omised Clinical Trial , number IS RCT N72675518 . FINDINGS Of the 253 couples enrolled , 127 were assigned  intrauterine insemination with controlled ovarian hyperstimulation and 126 expectant management . In the intervention group , 42 ( 33 % ) women conceived and 29 ( 23 % ) pregnancies were ongoing . In the expectant management group , 40 ( 32 % ) women conceived and 34 ( 27 % ) pregnancies were ongoing ( relative risk 0.85 , 95 % CI 0.63 - 1.1 ) . There was one twin pregnancy in each study group , and one woman in the intervention group conceived triplets . INTERPRETATION A large beneficial effect of intrauterine insemination with controlled ovarian hyperstimulation in couples with unexplained subfertility and an intermediate prognosis can be excluded . Expectant management for 6 months is therefore justified in these couples In the present prospect i ve study we compared , in terms of pregnancy rates , the differences between intrauterine insemination ( IUI ) of in vitro capacitated husb and 's semen and timed natural intercourse in spontaneous or clomiphene citrate ( CC ) stimulated cycles . A rapid urinary luteinizing hormone peak detection test was used for timing of ovulation . Forty patients suffering from longst and ing infertility of male ( n = 17 ) , cervical ( n = 2 ) , and idiopathic ( n = 21 ) origin were r and omly assigned into four distinct treatment modalities during 4 consecutive cycles . A total of 132 cycles were analyzed . In 35 cycles treated with CC plus IUI , five conceptions were achieved , whereas three pregnancies occurred in 32 inseminated spontaneous cycles . Only 1 patient conceived after timed intercourse in 31 CC stimulated cycles , and no pregnancy result ed from 34 spontaneous cycles combined with timed intercourse . There was a statistically significant higher conception rate in cycles in which IUI was performed , whereas the use of CC does not seem to improve the pregnancy rate . Analysis of results for other modifying factors did not substantially affect the relative risk ( odds ratio ) of pregnancy OBJECTIVE To assess if ovulation induction with gonadotropins alone is an appropriate treatment in couples affected by unexplained and mild male factor-related infertility and if the concomitant IUI improves the pregnancy rate ( PR ) . DESIGN Prospect i ve and r and omized trial . SETTING Infertility Centre of Department of Obstetrics and Gynecology of the University of Cagliari , Cagliari , Italy . PATIENTS Two hundred couples affected by unexplained or mild male factor-related infertility were assigned r and omly to one of two treatment groups : group A ( n = 100 ) , treated with three consecutive cycles of ovulation induction with gonadotropins associated with timed vaginal intercourse ; group B ( n = 100 ) , treated with three consecutive cycles of ovulation induction with gonadotropins associated with IUI . MAIN OUTCOME MEASURE Pregnancy rate . RESULTS The PRs obtained with ovulation induction with gonadotropins associated with IUI were similar to those obtained with ovulation induction with gonadotropins associated with timed vaginal intercourse . CONCLUSION Ovulation induction with gonadotropins alone may be as effective as ovulation induction with gonadotropins associated with IUI in couples with unexplained and mild male factor infertility and can represent the initial treatment option for its minimal invasivity and reduced cost and organizational problems OBJECTIVE To compare the pregnancy rates achieved by intrauterine insemination or timed intercourse in gonadotrophin stimulated cycles in couples whose only detectable abnormality was poor sperm quality . DESIGN Sixty-two couples with primary or secondary infertility due to male factor entered the study . The 62 couples were r and omly equally divided into two groups . Each group began one of the two treatment modalities ( controlled ovarian hyperstimulation in conjunction with timed intercourse or intrauterine insemination ) for three consecutive cycles and then switched to the alternative treatment after one rest cycle , if pregnancy was not achieved . RESULTS Five pregnancies ( 3.9 % ) were achieved after 128 cycles with timed intercourse and 15 pregnancies ( 11.5 % ) after 130 cycles with intrauterine insemination . The difference was found to be statistically significant ( P < 0.05 ) . CONCLUSION We suggest that intrauterine insemination during hMG stimulated cycles improves the pregnancy rates of couples whose only detectable abnormality is poor sperm quality Nineteen European fertility centres participated in a controlled r and omized trial aim ed at comparing the effectiveness of five methods for the treatment of unexplained infertility .  Each centre was invited to employ two of the five treatments being investigated , and the treatment allocated to individual patients was then decided by r and omization . The treatments were superovulation alone , and superovulation together with one of the following procedures : intra-uterine insemination ( IUI ) , intra-peritoneal insemination ( IPI ) , gamete intra-Fallopian transfer ( GIFT ) , in-vitro fertilization ( IVF ) .  All the patients admitted to the study had experienced greater than 36 months infertility prior to the start of the trial , and only patients less than 38 years of age were included in the investigation . Further , the study was confined to patients with normal Fallopian tubes , and where there was evidence of  spontaneous ovulation . Yet another prerequisite for inclusion in the study was that the male partner was ' normal ' as regards fertility . Due to unavoidable practical difficulties , the experimental design eventually obtained was severely unbalanced . Nevertheless , objective statistical comparisons were possible among the five treatments , using non-orthogonal analyses of variance . By the completion of the trial 444 patients had been treated in a total of 649 cycles . There was some statistical evidence that the pregnancy rate obtained from superovulation alone was inferior to that obtained by using superovulation together with one of the methods of assisted conception . ( ABSTRACT TRUNCATED AT 250 WORDS Forty-eight patients with male ( n = 16 ) or idiopathic ( n = 32 ) infertility were stimulated with human menopausal gonadotropin . Intrauterine insemination ( IUI ) or natural intercourse were performed after either human chorionic gonadotropin (hCG)-induced or spontaneous , urinary luteinizing hormone ( LH ) surge-monitored ovulation . A total of 148 cycles were analyzed . In 40 cycles treated with hCG-induced ovulation and IUI , 3 ( 7.5 % ) patients conceived , whereas 37 women accomplished natural intercourse after hCG-induced ovulation and 2 ( 5.5 % ) became pregnant . When inseminated after a spontaneous LH surge , 3 ( 8.8 % ) of 34 patients achieved a pregnancy ; no conception occurred in 37 spontaneously ovulatory cycles combined with timed intercourse . Pregnancy rates did not substantially differ between the treatment modalities or between mono-ovulatory 
    Output:
    
The additional benefit accruing to IUI , where TI is the control , is not significant , but it is consistent with the possibility that pregnancy may be less likely in TI controls than in expectant management controls