***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: PURPOSE The purpose of this prospect i ve , r and omized study was to compare ovarian response and oocyte and embryo yields in women undergoing ovulation induction for IVF/ICSI using recombinant human FSH ( rhFSH ) alone or in combination with recombinant human LH ( rhLH ) . METHODS Patients were r and omized to receive rhFSH alone ( group F ; n = 13 ) or rhFSH + rhLH ( group L ; n = 15 ) .  rhFSH was administered according to a step-down protocol ; patients assigned to group L received rhLH at a fixed dose of 75 IU ( 1 ampoule ) throughout the treatment period . RESULTS The total dose of rhFSH , number of growing follicles , and serum concentrations of estradiol ( E2 ) on the day of hCG administration were similar in both treatment groups . However , the percentage of metaphase II oocytes and fertilization rate were significantly higher in group F than in group L. The lower fertilization rates associated with rhLH were also seen in a subgroup of patients from group L who had undergone a previous ART cycle stimulated with FSH only and thus acted as their own controls . However , when in vitro fertilization ( IVF ) and intracytoplasmic sperm injection cycles were considered separately , differences in fertilization rates were statistically significant only for oocytes treated by conventional IVF . CONCLUSIONS This study shows that the addition of recombinant LH to recombinant FSH in pituitary-suppressed women undergoing ART does not improve the ovarian response and even may have a negative impact on oocyte maturation and fertilization OBJECTIVE To evaluate the effects of recombinant human luteinizing hormone ( rhLH ) supplementation on ovarian stimulation and implantation rate in down-regulated women of advanced reproductive age . DESIGN Prospect i ve r and omized study . SETTING University teaching hospital . PATIENT(S ) A total of 120 consecutive normogonadotropic infertile women > or = 35 years old undergoing their first cycle of IVF or intracytoplasmic sperm injection ( ICSI ) treatment . INTERVENTION(S ) Ovarian stimulation in a long agonist protocol with a combination of recombinant human follicle-stimulating hormone ( rhFSH ) and rhLH ( group 1 , n = 60 ) starting on day 6 of FSH stimulation until hCG at a daily fixed dose of 150 IU of rhLH , or with rhFSH alone ( group 2 , n = 60 ) . MAIN OUTCOME MEASURE(S ) Ovarian stimulation characteristics , ovum retrieval , and IVF/ICSI outcome . RESULT ( S ) The mean number of intermediate ( 10 - 14 mm ) and large ( > 14- < 18 mm ) but not leading ( > or = 18 mm ) follicles was significantly lower in group 1 on the day of hCG injection . The oocyte yield and maturity as well as the number of oocytes fertilized were significantly higher in group 2 than in group 1 . However , the number of patients having embryo transfer ( n = 55 in both treatment groups ) , the number and quality of embryos replaced , the implantation rate ( 20.6 % vs. 21.7 % ) and clinical pregnancy rates per embryo transfer ( 44 % vs. 45 % ) were similar in groups 1 and 2 . CONCLUSION ( S ) The rhLH supplementation does not increase ovarian response and implantation rates in patients of older reproductive age stimulated with rhFSH under pituitary suppression for assisted reproductive technologies ( ARTs ) Women undergoing intracytoplasmic sperm injection ( ICSI ) for male factor infertility were r and omly assigned to receive ovarian stimulation in a long agonist protocol with a combination of recombinant human FSH ( r-hFSH ; Gonal-F ) and recombinant human LH ( r-hLH ; Luveris ) ( n = 212 ) starting on day 6 of FSH stimulation until human chorionic gonadotrophin ( HCG ) at a daily fixed dose of 150 IU r-hLH , or with r-hFSH alone ( n = 219 ) . There was no significant difference in the number of metaphase II oocytes retrieved ( 10.3 versus 10.4 ) in patients treated with r-hFSH and r-hLH versus r-hFSH alone ; however , more embryos were transferred in the LH-supplemented group ( 2.9 versus 2.8 , P = 0.037 ) . Overall , the implantation rates were 22.9 versus 27.0 % in patients treated with r-hFSH and r-hLH versus with r-hFSH alone respectively ( NS ) . The respective numbers of MII oocytes retrieved in patients < 35 or > or=35 years were 11 versus 8.3 ( P = 0.010 ) for patients treated with r-hFSH alone , and 10.7 versus 9.3 ( NS ) for those given supplemental r-hLH ( 150 IU ) from day 6 . Implantation rates in patients < 35 years treated with r-hFSH were higher ( 30.7 % ) than those receiving r-hFSH and r-hLH , ( 23.5 % ) ( P = 0.068 ) . In patients > or=35 years , the implantation rates were 21.7 % for those patients supplemented with 150 IU r-hLH from day 6 of stimulation versus 15.7 % when treated with FSH alone ( NS ) . Younger patients therefore do not seem to benefit from an LH-supplemented ovarian stimulation protocol , but women > or=35 years undergoing assisted reproduction may benefit from using r-hLH in addition to r-hFSH BACKGROUND Poor ovarian response is a common clinical problem , affecting up to 26 % of IVF cycles . For these women , addition of recombinant luteinizing hormone ( rLH ) to ovarian hyperstimulation with recombinant FSH has a beneficial effect on ongoing pregnancy rates , but its effect on the yield of top- quality embryos is unknown . METHODS We conducted a r and omized controlled trial in women expected to respond poorly under ovarian hyperstimulation during their first IVF cycle [ all women aged 35 - 41 and women with FSH > 12 IU/ml and antral follicle count ( AFC ) ≤ 5 ] . Women were r and omly allocated to rFSH and rLH ( 2:1 ratio ) or rFSH alone ( control group ) after down-regulation with a GnRH agonist . The primary outcome was the proportion of top- quality embryos per woman on the day of transfer . Secondary outcomes were the number of stimulation days , the number of follicles ≥17 mm , the number of oocytes , the fertilization rate , the number of embryos , the number of women with ≥1 top- quality embryo , the biochemical , clinical and ongoing pregnancy rates and the miscarriage rate . RESULTS There were 116 women allocated to the rLH group and 128 allocated to the control group .  The proportion of top- quality embryos per woman was 17 % in the rLH group and 11 % in the control group [ mean difference 0.06 ; 95 % confidence interval ( CI ) -0.01 - 0.14 ] . In the rLH and control groups respectively , 47 ( 41 % ) and 41 ( 32 % ) women had at least one top- quality embryo on the day of transfer ( relative risk : 1.3 , 95 % CI 0.91 - 1.77 ) . The ongoing pregnancy rate was 13 versus 12 % ( relative risk : 1.1 ; 95 % CI 0.57 - 2.16 ) for the rLH group compared with the control group . CONCLUSIONS This study found no significant difference in embryo quality after the addition of rLH to rFSH for ovarian stimulation in women with poor ovarian reserve . CLINICAL TRIALS IDENTIFIER NTR1457 This single-centre , r and omized , parallel group , comparative study aim ed to identify potential benefits of mid-follicular recombinant human LH ( r-HLH ) supplementation in women aged 35 - 39 years undergoing ovarian stimulation for intracytoplasmic sperm injection ( ICSI ) . The main endpoint was the number of metaphase II oocytes retrieved . After pituitary suppression with a gonadotrophin-releasing hormone agonist , ovarian stimulation was initiated with recombinant human FSH ( r-HFSH ; 300 - 450 IU/day ) . On stimulation day 6 , patients were r and omized to receive r-HFSH alone or r-HFSH + r-HLH ( r-HLH 150 IU/day ) for the remainder of the stimulation period . Final follicular maturation was triggered with 250 mug of recombinant human chorionic gonadotrophin . After assessing oocyte nuclear maturity , oocyte were fertilized by ICSI and afterwards embryo quality was analyzed . Of the 131 women enrolled , 68 were allocated to r-HFSH alone and 63 to r-HFSH + r-HLH . No significant differences were observed in markers of either oocyte or embryo quality or quantity . However , higher rates of implantation and live birth per started cycle were observed with r-HLH supplementation than with r-HFSH alone . Although additional large studies are required to further investigate these findings , r-HLH supplementation for women aged 35 - 39 years undergoing ICSI is recommended as it may have a beneficial action on implantation BACKGROUND In approximately 12 - 14 % of young normogonadotrophic women treated with a depot GnRH agonist long protocol , the initial ovarian response to recombinant human FSH ( rFSH ) can be suboptimal . We have tested the hypothesis that these women may benefit from recombinant human LH ( rLH ) supplementation in a multicentre , prospect i ve , r and omized trial compared with patients treated with an rFSH step-up protocol . METHODS A total of 260 young normogonadotrophic women undergoing controlled ovarian stimulation with a GnRH agonist long protocol for IVF/ICSI were enrolled . The starting dose of rFSH was 225 IU . One hundred and thirty patients with serum estradiol levels < 180 pg/ml and with at least six follicles with a mean diameter > 5 mm but none > 10 mm on both day 5 and day 8 of stimulation were r and omly allocated to two groups . From the eighth day of stimulation , women in group A ( n=65 ) received 150 IU of rLH in addition to rFSH , while those in group B ( n=65 ) had an increase of 150 IU in the daily dose of rFSH ( step-up protocol ) . One hundred and thirty normally responding women continued monotherapy with rFSH and served as a further control population ( group C ) . RESULTS The mean number of cumulus-oocyte complexes retrieved in group A ( 9.0+/-4.3 ) was significantly higher ( P<0.01 ) compared with group B ( rFSH 6.1+/-2.6 ) but significantly lower compared with group C ( 10.49+/-3.7 , P<0.05 ) . Implantation and pregnancy rates were significantly lower ( P<0.05 ) in the rFSH step-up group ( 10.5 and 29.3 % respectively ) when compared with normal responders ( 18.1 and 47.3 % respectively ) . CONCLUSIONS rLH supplementation is more effective than increasing the dose of rFSH in terms of ovarian outcome in patients with an initial inadequate ovarian response to rFSH alone BACKGROUND The effect of recombinant human LH ( r-hLH ; lutropin alfa ) in women undergoing controlled ovarian stimulation with recombinant human FSH ( r-hFSH ) prior to IVF was investigated . METHODS After down-regulation with the GnRH agonist , buserelin , 114 normo-ovulatory women ( aged 18 - 37 years ) received r-hFSH alone until the lead follicle reached a diameter of 14 mm . Patients were then r and omized in a double-blind fashion to receive r-hFSH in addition to r-hLH , 75 IU s.c . , or placebo daily for a maximum of 10 days prior to oocyte retrieval and IVF . The primary end-point was the number of metaphase II oocytes . RESULTS There were no significant differences between treatment groups for the primary end-point . Serum estradiol concentrations on the day of HCG administration were significantly higher in the group receiving r-hLH plus r-hFSH than in the group receiving r-hFSH alone ( P = 0.0001 ) , but there were no significant differences between the groups in dose and duration of r-hFSH treatment required , oocyte maturation , fertilization rate , pregnancy rate and live birth rate . CONCLUSION In this patient population , the addition of r-hLH during the late follicular phase of a long GnRH agonist and r-hFSH stimulation cycle provides no further benefit in terms of oocyte maturation or other end-points OBJECTIVE To prospect ively assess the effect of using a combination of recombinant follicle-stimulating hormone ( rFSH ) and recombinant luteinizing hormone ( rLH ) on ovarian stimulation parameters and treatment outcome among poor-responder patients . DESIGN Prospect i ve r and omized trial . SETTING University-associated private medical center . P 
    Output:
    
In conclusion , this meta- analysis suggests that the addition of r-hLH to r-hFSH may be beneficial for women with POR