***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 investigate the utility of r and om anti-Müllerian hormone ( AMH ) in assessing ovarian response among women with diminished ovarian reserve ( DOR ) diagnosed by elevated early follicular-phase FSH levels . DESIGN Retrospective study . SETTING Academic and academically affiliated assisted reproductive technology ( ART ) programs . PATIENT(S ) Seventy-three women undergoing ART with elevated early follicular FSH levels . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Number of oocytes retrieved during ART cycle , number of day 3 embryos , and cycle cancellation and clinical pregnancy rates . RESULT ( S ) R and  om AMH  levels were strongly correlated with the number of oocytes retrieved during an ART cycle among women with elevated FSH ( r=0.55 ) . Women with elevated FSH who had a r and om serum AMH level of 0.6 ng/mL or higher had twice the number of oocytes retrieved ( 11±1.3 vs. 5.6±0.6 ) , a greater number of day 3 embryos ( 5.7±0.9 vs. 3±0.5 ) , and approximately a third of the cycle cancellation rate ( 14 % vs. 41 % ) compared with women with a r and om serum AMH below 0.6 ng/mL. The clinical pregnancy rate was also higher among women with a r and om serum AMH≥0.6 ng/mL ( 28 % vs. 14 % ) , however , the difference was not statistically significant . CONCLUSION ( S ) A r and om serum  AMH level is useful in setting expectations for ART prognosis in women with elevated early follicular-phase serum FSH levels OBJECTIVE To evaluate the relationship between serum anti-Müllerian hormone ( AMH ) and antral follicle size , and to ascertain which cohort of antral follicles is most predictive of the response to controlled ovarian stimulation during assisted reproduction treatment ( ART ) . DESIGN Prospect i ve study . SETTING University-based Assisted Conception Unit . PATIENT(S ) One hundred thirteen women undergoing first cycle of ART . INTERVENTION(S ) Transvaginal 3D-ultrasound assessment and venipuncture in the early-follicular phase of the menstrual cycle . MAIN OUTCOME MEASURE(S ) Serum AMH levels , number of mature oocytes retrieved and poor ovarian response . RESULT ( S ) The antral follicle cohorts measuring 2 to 3 mm , > 3 to 4 mm , > 4 to 5 mm , and > 5 to 6 mm were most significantly correlated with AMH ( r = .30 , .27 , .30 , and .41 , respectively ) and the number of mature oocytes retrieved ( r = .28 , .23 , .29 , and .34 , respectively ) . Although these follicle cohorts of 2 - 6 mm were significant predictors of the number of mature oocytes retrieved on regression analysis , their discriminative ability ( area under the curve [ AUC ] : 0.829 ) for the prediction of poor ovarian response was similar to total counts made using cohorts of 2 to 4 mm , 2 to 5 mm , 2 to 8 mm , and 2 to 10 mm ( AUCs : 0.794 , 0.812 , 0.852 , and 0.826 , respectively ) . CONCLUSION ( S ) The number of antral follicles measuring 2 to 6 mm is most reflective of the quantitative ovarian reserve . However , the ability of this group of antral follicles to predict poor ovarian response appears similar to that of the follicular cohorts of 2 to 4 mm , 2 to 5 mm , 2 to 8 mm , and 2 to 10 mm BACKGROUND Diminished ovarian reserve has become a major cause of infertility . Anti-Mullerian hormone ( AMH ) seems to be a promising c and i date to assess ovarian reserve and predict the response to controlled ovarian hyperstimulation ( COH ) . This prospect i ve study was conducted to evaluate the relevance of AMH in a routine IVF program . METHODS Three hundred and sixteen patients were prospect ively enrolled to enter their first IVF/ICSI-cycle .  Age , FSH- , inhibin B- and AMH-levels and their predictive values for ovarian response and clinical pregnancy rate were compared by discriminant analyses . RESULTS A total of 132 oocyte retrievals were performed . A calculated cut-off level < or = 1.26 ng/ml AMH alone detected poor responders ( < or = 4 oocytes ) with a sensitivity of 97 % , and there was a 98 % correct prediction of normal response in COH if levels were above this threshold . With levels < 0.5 ng/ml , a correct prediction of very poor response ( < or = 2 oocytes ) was possible in 88 % of cases . Levels of  AMH  > or = 0.5 ng/ml were not significantly correlated with clinical pregnancy rates . CONCLUSIONS  AMH  is a predictor of ovarian response and suitable for screening . Levels < or = 1.26 ng/ml are highly predictive of reduced ovarian reserve and should be confirmed by a second line antral follicle count . Measurement of AMH supports clinical decisions , but alone it is not a suitable predictor of IVF success 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 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 evaluate the efficacy of GnRH antagonist in comparison with the GnRH agonist protocol in OCP pretreated polycystic ovary syndrome ( PCOs ) patients undergoing their first ART cycle . Material s and methods Prospect i ve r and omized controlled trial . University-based tertiary fertility center . Ninety-five PCOs patients under 35 years of age , with primary infertility were r and omized to an ovarian stimulation protocol consisting of either . GnRh antagonist ( study group ) or GnRH agonist ( control group ) after pretreatment with OCP . Coasting or GnRH agonist Trigger was used when estradiol level ≥3,000 pgr/ml in the control and study group , respectively . Both groups received 800 mg vaginal progesterone and 4 mg oral estradiol valerate for luteal phase support . Results There was no statistically significant difference in the age , body mass index , basal FSH , duration of infertility , the number of oocytes retrieved , the number of embryos transferred , Serum E2 levels on day of trigger , fertilization rate , chemical and clinical pregnancy rates between the two groups . None of the patients in the study group developed ovarian hyperstimulation syndrome ( OHSS ) compared with 22.2 % of patients in the control group . Total duration of treatment and the number of HMG ampoules used were lower in the study group . Conclusion Antagonist protocol and GnRH agonist trigger for ovulation whenever necessary has a similar cycle outcome to the GnRH-agonist protocol in OCP pretreated PCOs patients , with significantly reduced risk of OHSS BACKGROUND We evaluated basal and dynamic hormonal markers [ ( FSH , inhibin B , estradiol and anti-Mullerian hormone ( AMH ) ]  during the follicular phase and luteal phase of the menstrual cycle and ultrasonic ovarian morphology as predictors of IVF outcome . METHODS Fifty-six women , aged < 38 years , with normal day 3 FSH levels were included prospect ively .  Serum estradiol , inhibin B and AMH were measured before and 24 h after administration of 300 IU of recombinant FSH on cycle day 3 - 4 and during the luteal phase .  Ovarian volume and antral follicle count ( AFC ) were evaluated on cycle day 3 - 4 . The predictive value of oocyte number and pregnancy were assessed using uni- and multivariate analysis . RESULTS Poor responders ( < 6 oocytes ) had significantly lower luteal AMH levels , while high responders ( > 20 oocytes ) had significantly higher AFC , AMH and luteal stimulated inhibin B and estradiol than normal responders . Multivariate regression analyses showed that the best models for predicting oocyte number included AFC , follicular phase AMH and stimulated inhibin B. Only AMH showed a significant difference between pregnant and non-pregnant women at both cycle phases . CONCLUSIONS In young women ( < 38 years ) , AFC or basal AMH and stimulated inhibin B predict ovarian response for IVF . The only predictor for pregnancy is follicular or luteal phase AMH BACKGROUND Women with polycystic ovary syndrome ( PCOS ) are at risk of developing ovarian hyperstimulation syndrome ( OHSS ) during ovarian stimulation . Use of GnRH antagonist in the general subfertile population is associated with lower incidence of OHSS than agonists and similar probability of live birth but it is unclear if this is true for patients with PCOS . Our aim was to compare the flexible GnRH antagonist and GnRH agonist long protocol s in patients with PCOS undergoing IVF ( primary end-point : ongoing pregnancy rate per patient r and omized ) . METHODS In this r and omised controlled trial ( RCT ) , 220 patients with PCOS were r and omly allocated in two groups : long GnRH agonist down-regulation protocol ( n = 110 ) and flexible GnRH antagonist protocol ( n = 110 ) . RESULTS No differences were observed in ongoing pregnancy rates [ 50.9 versus 47.3 % , difference 3.6 % , 95 % confidence interval ( CI ) : -9.6 to + 16.8 % ] in the agonist and antagonist protocol s , respectively . Incidence of OHSS Grade II was lower in the antagonist compared with agonist group ( 40.0 versus 60.0 % , difference -20.0 % , 95 % CI : -7.1 to -32.9 % , P < 0.01 ) . Duration of stimulation ( 10 versus 12 days , difference 2 days , 95 % CI : + 1 to + 2 
    Output:
    
The selection of the appropriate and individualized gonadotrophin dose is also of paramount importance for effective COS and subsequent IVF outcomes .
Personalized IVF offers several benefits ; it enables clinicians to give women more accurate information on their prognosis thus facilitating counselling especially in cases of extremes of ovarian response .