***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: A prospect i ve , r and omized , open , multicentre ( n = 3 ) study was conducted to compare the efficacy and efficiency of a fixed daily dose of 150 IU ( 3x50 IU ) recombinant follicle stimulating hormone ( recFSH , Puregon((R ) ) ) and 225 IU ( 3x75 IU ) highly purified urinary FSH ( uFSH-HP , Metrodin-HP((R ) ) ) in women undergoing ovarian stimulation prior to in-vitro fertilization treatment . A total of 165 women were treated with FSH , 83 subjects with recFSH and 82 subjects with uFSH-HP .  In the recFSH group a mean number of 8.8 oocytes were retrieved , compared with 9.8 in the uFSH-HP group ( not statistically significant ) . In the recFSH group , a significantly lower total dose was required compared to the uFSH-HP group , 1479 versus 2139 IU , respectively ( P < 0.0001 ; 95 % confidence interval -747 to -572 ) . Treatment with recFSH result ed in a significantly higher embryo development rate ( 69.6 versus 56.2 % ; P = 0.003 ) and more embryos accessible for the embryo freezing programme ( 3.3 versus 2.0 ; P = 0.02 ) compared to uFSH-HP .  The vital pregnancy rate per cycle started was 30.2 versus 28.3 % in the recombinant and urinary FSH group , respectively . It is concluded that treatment outcome of a fixed daily dose of 150 IU recFSH is comparable to a fixed daily dose of 225 IU uFSH-HP . However , a significantly lower total dose was needed in the recFSH group ( nearly 700 IU less ) A prospect i ve and r and omized study of ovarian stimulation with human recombinant follicle-stimulating hormone ( r-FSH ; Gonal-F ) versus highly purified urinary FSH ( u-FSH-HP ; Metrodin-HP ) was conducted on patients su bmi tted to an intracytoplasmic sperm injection ( ICSI ) program . A total of 120 patients aged 37 years or less were stimulated in a r and omized manner with r-FSH ( group I = 60 patients ) or u-FSH-HP ( group II = 60 patients ) . All received a fixed dose of FSH for 7 days and on the 8th day of stimulation the doses started to be adapted according to ovarian response . Human chorionic gonadotropin ( hCG ) at the dose of 5000 IU to 10000 IU was administered to both groups when at least one follicle presented a diameter ≥ 17 mm . The ovarian response did not differ significantly between groups I and II in terms of number of follicles ≥ 16 mm ( group I = 6.2 ± 3.2 ; group II = 6.7 ± 2.9 ; p = 0.26 ) , number of oocytes collected ( group I- 10.7 ± 6.8 ; group II = 10.5 ± 5.7 ; p = 0.91 ) , number of oocytes in metaphase II ( group I = 9.2 ± 5.8 ; group II = 8.2 ± 4.8 ; p = 0.56 ) or number of immature oocytes ( group I = 1.8 ± 0.9 ; group II = 1.9 ± 1.7 ; p = 0.62 ) . The normal fertilization rate after ICSI did not differ significantly between treatments ( group I = 69.4 ± 25 ; group II = 66.5 ± 23 ; p = 0.38 ) . No cases of cancellation of ovarian stimulation or of severe ovarian hyperstimulation syndrome occurred in either group . The total number of embryos obtained from patients who used r-FSH ( group I = 6.3 ± 4.5 ) was similar ( p = 0.46 ) to the number obtained from patients who used u-FSH-HP ( group II = 5.5 ± 3.7 ) , as also was the number of transferred embryos ( group I = 2.8 ± 0.8 ; group II = 2.6 ± 0.9 ; p = 0.27 ) . Implantation rate ( 26.1 % ) and clinical pregnancy rates per puncture ( 36.7 % ) and per embryo transfer ( 37.9 % ) were higher in patients who used r-FSH than in patients who used u-FSH-HP ( 19.5 % , 31.7 % and 32.2 % , respectively ) , but the differences were not statistically significant . The abortion rate ( p = 0.32 ) did not differ between groups ( group I = 4.5 % , n = 1 versus group II = 15.7 % , n = 3 ) . Thus far , the data do not demonstrate significant differences in ovary stimulation with r-FSH versus u-FSH in patients whose indication for assisted reproduction was the male factor Background These data compare the efficacy and safety of highly purified human-derived follicle-stimulating hormone ( Bravelle(R ) ) and recombinant follitropin-β ( Follistim(R ) ) in women undergoing in vitro fertilization . Methods This report describes the pooled data from two , nearly identical , r and omized , controlled , parallel-group , multicenter studies conducted in a total of 19 academic and private IVF-ET centers in the United States . Infertile premenopausal women underwent pituitary down-regulation using leuprolide acetate followed by a maximum of 12 days of subcutaneous Bravelle(R ) ( n = 120 ) or Follistim(R ) ( n = 118 ) , followed by administration of human chorionic gonadotropin , oocyte retrieval and embryo transfer . The primary efficacy measure was the mean number of oocytes retrieved ; secondary efficacy measures included the total dose and duration of gonadotropin treatment ; peak serum estradion levels ; embryo transfer and implantation rates ; chemical , clinical and continuing pregnancies ; and live birth rates . All adverse events were recorded and injection site pain was recorded daily using a patient , self- assessment diary . Results Similar efficacy responses were observed for all outcome parameters in the two treatment groups . Although patients receiving Bravelle(R ) consistently reported a greater number of chemical , clinical and continuing pregnancies , as well as an increased rate of live birth , the data did not attain statistical significance ( P > 0.05 ) . The overall incidence of adverse events was similar in both groups , but compared to Follistim(R ) , injections of Bravelle(R ) were reported by patients to be significantly less painful ( P < 0.001 ) . Conclusions Bravelle(R ) and Follistim(R ) had comparable efficacy in controlled ovarian hyperstimulation in women undergoing IVF-ET . There were no differences in the nature or number of adverse events between the treatment groups although Bravelle(R ) injections were reported to be significantly less painful OBJECTIVE To compare the effectiveness of highly purified hMG with recombinant FSH ( rFSH ) in IVF-intracytoplasmic sperm injection patients who were treated with a GnRH agonist .  DESIGN An open-label , prospect i ve , r and omized comparison of fixed gonadotropin regimens . SETTING Eighteen Dutch IVF centers . PATIENT(S ) Six hundred twenty-nine patients who were selected for IVF-intracytoplasmic sperm injection . INTERVENTION(S ) Patients were r and omized to receive either highly purified hMG or rFSH in a fixed dosage of 150 IU/d after GnRH-agonist suppression ( long protocol ) . MAIN OUTCOME MEASURE(S ) Ongoing pregnancy rate per started cycle . Difference between the two treatment groups was tested by using odds ratios , including the 95 % confidence limits ( intention-to-treat sample ) , and by using the Fisher 's exact test ( per- protocol sample ) . RESULT ( S ) The ongoing pregnancy rates per started cycle were 26.3 % and 25.2 % for highly purified hMG and rFSH , respectively ( no statistically significant difference ) . Treatment with highly purified hMG result ed in statistically significantly fewer oocytes ( n = 7.8 ) than did treatment with rFSH ( n = 10.6 ) . There were no differences with respect to fertilization rates and implantation rates . Cycles with highly purified hMG were statistically significantly less often canceled as a result of ovarian hyperresponse ( 2.0 % vs. 6.0 % for highly purified hMG and rFSH , respectively ) . CONCLUSION ( S ) Compared with rFSH , highly purified hMG did not result in superiority in ongoing pregnancy rates in first-cycle IVF-intracytoplasmic sperm injection patients who were treated with a fixed dosage of 150 IU of gonadotropin per day . Compared with rFSH , treatment with highly purified hMG result ed in retrieval of fewer oocytes , a lower incidence of hyperresponse , and comparable pregnancy rates OBJECTIVE The following study was conducted to determine which FSH , recombinant or urinary , works better in older women . DESIGN We conducted a controlled r and omized study in a single university IVF center . SETTING University IVF center . PATIENT(S ) Women ( N = 257 ) over 39 years old undergoing IVF .  INTERVENTION(S ) The patients were r and omized into two study groups at their first IVF cycle : 121 patients were treated with recombinant FSH , and 120 patients were treated with urinary FSH . Both groups were suppressed with a long GnRH analog protocol . MAIN OUTCOME MEASURE(S ) Days of stimulation , E2 at the day of hCG , total amount of FSH administered , number of oocytes collected , amount of FSH per oocyte , and number of embryos obtained . RESULT ( S ) Patients treated with urinary FSH required a significantly lower total amount of FSH , and a lower amount of FSH per oocyte than women treated with recombinant FSH . The other measures evaluated did not show any statistically significant differences . CONCLUSION ( S ) Our study showed that urinary FSH performed better in older women than recombinant FSH when associated with the long protocol Objective : To compare highly purified human menopausal gonadotropin ( HP-hMG ) with recombinant follicle-stimulating hormone ( rFSH ) on ovarian response and pregnancy outcome in downregulated women of advanced reproductive age . Design : A prospect i ve , r and omized and controlled study of 127 consecutive normogonadotropic infertile women ≥35 years old undergoing their first in vitro fertilization/intracytoplasmic sperm injection cycles received ovarian stimulation with HP-hMG ( n = 63 ) or with rFSH ( n = 64 ) in a long gonadotropin-releasing hormone agonist protocol . Results : More leading ( ≥18 mm ) follicles and oocytes were obtained in rFSH group ( p = 0.008 and p < 0.001 , respectively ) . The proportion of top- quality embryo from oocyte retrieval and live birth rate per started cycle trended towards improvement with HP-hMG ( OR 1.3 , 95 % CI 0.9–1.8 ; OR 1.9 , 95 % CI 0.9–3.9 ; respectively ) , although they were not significant difference between two groups . At end of stimulation , higher serum progesterone level was found in rFSH group ( p < 0.001 ) . Conclusion : Following downregulated women of advanced reproductive age , superiority of HP-hMG over rFSH  in live birth rate could not be concluded from this study , but noninferiority was established . Pharmacodynamic differences in follicular development , oocyte/embryo quality and endocrine response exist between HP-hMG and rFSH , which may be relevant to treatment outcome BACKGROUND LH activity may influence treatment response and outcome in IVF cycles . METHODS A r and omized , assessor-blind , multinational trial compared ongoing pregnancy rates ( primary end-point ) in 731 women undergoing IVF after stimulation with highly purified menotrophin ( HP-hMG ) ( n = 363 ) or recombinant FSH ( rFSH ) ( n = 368 ) following a long GnRH agonist protocol .  Patients received identical pre- and post-r and omization interventions . One or two embryos were transferred on day 3 . RESULTS More oocytes were retrieved ( P < 0.001 ) after rFSH treatment ( 11.8 ) compared with HP-hMG treatment ( 10.0 ) , but a higher proportion developed into top- quality embryos ( P = 0.044 ) with HP-hMG ( 11.3 % ) than with rFSH ( 9.0 % ) . At the end of stimulation , lower estradiol ( E(2 ) ) ( P = 0.031 ) and higher progesterone ( P < 0.001 ) levels were found with rFSH , even after adjusting for follicular response . The distribution of hypo- , iso- and hyper-echogenic endometrium showed a significant ( P = 0.023 ) shift towards the hyperechogenic pattern after rFSH treatment . The ongoing pregnancy rate per cycle was 27 % with HP-hMG and 22 % with rFSH [ odds ratio ( 95 % confidence interval ) : 1.25 ( 0.89 - 1.75 ) ] . CONCLUSION 
    Output:
    
SUMMARY ANSWER The difference between recombinant and urinary-derived HP-hMG or HP-FSH in the required amount to reach a live birth in IVF/ICSI cycles appears small .
A small fraction of women did not start gonadotrophin treatment ; this was usually not accounted for in the provided mean amount of gonadotrophins per study and might have affected the averaged total amount of gonadotrophins but is unlikely to have affected the differences in the amount between rFSH and HP-hMG or HP-FSH .
WIDER IMPLICATION S OF THE FINDINGS The differences in the required amount to reach a live birth between rFSH , HP-hMG and HP-FSH appear to be small .