***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: We identified patients who experienced ovarian hyperstimulation syndrome ( OHSS ) ( n = 16 ) and compared their baseline pretreatment levels of müllerian-inhibiting substance ( MIS ) to age- and weight-matched patients with normal responses to gonadotropins ( n = 14 ) .  Baseline serum MIS in patients with OHSS were sixfold higher than those seen in normal controls ( 3.62 + /- 0.87 vs. 0.63 + /- 0.09 ng/mL ; P=.0036 ) , indicating that MIS could potentially serve as a useful marker for identifying patients at risk for OHSS 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 To test whether ovarian stimulation for in-vitro fertilization ( IVF ) affects oocyte quality and thus chromosome segregation behaviour during meiosis and early embryo development , preimplantation genetic screening of embryos was employed in a prospect i ve , r and omized controlled trial , comparing two ovarian stimulation regimens . METHODS Infertile patients under 38 years of age were r and omly assigned to undergo a mild stimulation regimen using gonadotrophin-releasing hormone ( GnRH ) antagonist co-treatment ( 67 patients ) , which does not disrupt secondary follicle recruitment , or a conventional high-dose exogenous gonadotrophin regimen and GnRH agonist co-treatment ( 44 patients ) . Following IVF , embryos were biopsied at the eight-cell stage and the copy number of 10 chromosomes was analysed in 1 or 2 blastomeres . RESULTS The study was terminated prematurely , after an unplanned interim analysis ( which included 61 % of the planned number of patients ) found a lower embryo aneuploidy rate following mild stimulation . Compared with conventional stimulation , significantly fewer oocytes and embryos were obtained following mild stimulation ( P < 0.01 and < 0.05 , respectively ) . Consequently , both regimens generated on average a similar number ( 1.8 ) of chromosomally normal embryos . Differences in rates of mosaic embryos suggest an effect of ovarian stimulation on mitotic segregation errors . CONCLUSIONS Future ovarian stimulation strategies should avoid maximizing oocyte yield , but aim at generating a sufficient number of chromosomally normal embryos by reduced interference with ovarian physiology Purpose To evaluate the predictive value of basal serum anti-müllerian hormone level and small antral follicle count for high ovarian response to controlled ovarian hyperstimulation . Methods A total of 159 patients were prospect ively included .  Basal serum anti-müllerian hormone and small antral follicle count  ( 2–6 mm ) were measured . Results Small antral follicle count and anti-müllerian hormone have similar predictive accuracy for high ovarian response with area under curve of 0.961 and 0.922 , respectively . The sensitivity and specificity for prediction of high ovarian response were 89 % and 92 % for small antral follicle count and 93 % and 78 % for anti-müllerian hormone at the cutoff values of ≥ 16 and ≥ 34.5 pmol/l , respectively . Conclusions Small antral follicle count and anti-müllerian hormone are equally accurate predictors of high ovarian response and facilitate determination of the optimal strategy for controlled ovarian hyperstimulation The effect of 100 and 200 IU per day recombinant FSH ( rFSH ) on numbers of oocytes retrieved and the total dose used in ovarian stimulation before intracytoplasmic sperm injection was investigated in a double-blind , r and omized multicentre trial . A total of 91 women was treated with a low-dose protocol and 88 with a high-dose regimen at five centres . For each started cycle , significantly more oocytes were retrieved in the 200 IU group than in 100 IU group ( 12.0 versus 5.7 , P < 0.001 ) ; total rFSH consumption was 1121 and 1875 IU in the low- and high-dose groups respectively . Significant variations were noted between centres with regard to numbers of oocytes collected per started cycle , ranging from 2.8 to 7.2 in the 100 IU group and from 9.0 to 19.1 in the high-dose group . Exploratory analyses of secondary outcomes suggested there were no differences in vital pregnancy rates per started cycle ( 19.2 versus 16.9 % ) and per embryo transfer ( 26.2 versus 19.3 % ) in the low- and high dose groups respectively . There were four hospitalizations due to ovarian hyperstimulation syndrome , all in the 200 IU group BACKGROUND  Anti-Müllerian hormone ( AMH ) , secreted by the granulosa cells of preantral and small antral follicles , has been described as a potential marker of the ovarian reserve . The aim of this prospect i ve study is to investigate the variations of  AMH  during the menstrual cycle in a young selected population of normo-ovulatory women and to analyse the correlation with other cyclic hormones . METHODS Twenty healthy volunteers from 19 to 35 years old , with regular menstrual cycles ( 26 - 31 days ) , normal ovulation ( day 10 - 16 ) , normal hormonal profile and normal body mass index ( 18 - 26 kg/m2 ) were recruited .  AMH , inhibin B , LH , FSH , estradiol and progesterone were measured on days 3 , 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 18 , 21 and 25 of a spontaneous cycle . RESULTS  AMH serum levels , either expressed by cycle day or aligned according to the ovulation day , did not show any significant variations during the menstrual cycle . CONCLUSIONS No significant fluctuation of the  AMH level during the menstrual cycle was observed . Therefore , this hormone is particularly interesting for clinical evaluation of the ovarian reserve as it may be used at any time during the cycle BACKGROUND Serum anti-Müllerian hormone ( AMH ) levels provide a powerful means for predicting ovarian response , which is reflected not only by the size of the primordial follicle pool but also by the quality of the oocytes . Considering a mutual interdependence between AMH-expressing somatic cells and gametes , this prospect i ve morphological study was set up to evaluate whether extreme AMH levels represent diminished oocyte quality and developmental incompetence . METHODS A total of 141 consecutive ICSI patients were subdivided into three groups using the 25th and 75th percentiles of the serum AMH levels ( cycle day 3 ) . In these three groups , morphology of all oocytes and fertilization rate , embryo quality and blastocyst formation were evaluated , and  FSH , LH and estradiol ( E(2 ) ) levels were also measured . RESULTS Cycle cancellation rate was correlated with AMH levels ( P < 0.05 ) . AMH groups 1 ( < 1.66 ng/ml ) and 3 ( > 4.52 ng/ml ) showed oocytes of lower quality [ dark central granulation , aggregation of smooth endoplasmic reticulum ( sER ) ] compared with the median group 2 ( 1.66 - 4.52 ng/ml ) . Basal serum FSH did not allow for adequate prognosis in terms of gamete appearance . Fertilization and further cleavage up to blastocyst stage was not affected by AMH levels . CONCLUSIONS AMH seems to be superior to FSH in predicting both oocyte number and quality CONTEXT Anti-Müllerian hormone ( AMH ) , a quantitative marker for ovarian reserve , has been suggested to be independent of the classical endocrine fluctuations of the menstrual cycle . OBJECTIVE The objective of the study was to determine whether AMH levels are constant throughout the menstrual cycle , compared with those of FSH , LH , and estradiol . DESIGN / PATIENTS Frequent blood sampling was performed in 44 fertile , regularly cycling , female volunteers during one full menstrual cycle . SETTING The study was conducted at a university hospital . MAIN OUTCOME MEASURES AMH , FSH , LH , and estradiol measurements were allocated to one of seven cycle phases , and a multilevel analysis was performed . Consistent fluctuation patterns were tested by fitting sine patterns to the data . Finally , the frequency in which r and omly selected individual sample s would remain in one of five preset level categories ( quintiles ) for each of the variables was studied . RESULTS A sine pattern fitted to the AMH data was not statistically significant ( P = 0.40 ) . In contrast , sine patterns for FSH , LH , and estradiol were highly significant . Comparing the seven cycle phases , no significant differences could be observed between phase-specific AMH levels ( P = 0.06 ) . Repeated selection of AMH sample s for each individual showed that in 71.5 % of selection s ,  AMH values remained in the same quintile , whereas in 27.9 % values fell in an adjacent quintile . CONCLUSIONS  AMH levels measured through a full menstrual cycle did not show consistent fluctuation patterns in contrast to levels of FSH , LH , and estradiol . Furthermore , r and om fluctuations were small , indicating that AMH can be relied on as a cycle-independent marker for ovarian reserve BACKGROUND Mild in-vitro fertilisation ( IVF ) treatment might lessen both patients ' discomfort and multiple births , with their associated risks . We aim ed to test the hypothesis that mild IVF treatment can achieve the same chance of a pregnancy result ing in term livebirth within 1 year compared with st and ard treatment , and can also reduce patients ' discomfort , multiple pregnancies , and costs . METHODS We did a r and omised , non-inferiority effectiveness trial . 404 patients were r and omly assigned to undergo either mild treatment ( mild ovarian stimulation with gonadotropin-releasing hormone [ GnRH ] antagonist co-treatment combined with single embryo transfer ) or a st and ard treatment ( stimulation with a GnRH agonist long- protocol and transfer of two embryos ) . Primary endpoints were proportion of cumulative pregnancies leading to term livebirth within 1 year after r and omisation ( with a non-inferiority threshold of -12.5 % ) , total costs per couple up to 6 weeks after expected date of delivery , and overall discomfort for patients . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Clinical Trial , number IS RCT N35766970 . FINDINGS The proportions of cumulative pregnancies that result ed in term livebirth after 1 year were 43.4 % with mild treatment and 44.7 % with st and ard treatment ( absolute number of patients = 86 for both groups ) . The lower limit of the one-sided 95 % CI was -9.8 % . The proportion of couples with multiple pregnancy outcomes was 0.5 % with mild IVF treatment versus 13.1 % ( p<0.0001 ) with st and ard treatment , and mean total costs were 8333 euros and 10745 euros , respectively ( difference 2412 euros , 95 % CI 703 - 4131 ) . There were no significant differences between the groups in the anxiety , depression , physical discomfort , or sleep quality of the mother . INTERPRETATION Over 1 year of treatment , cumulative rates of term livebirths and patients ' discomfort are much the same for mild ovarian stimulation with single embryos transferred and for 
    Output:
    
Both AMH and AFC are accurate predictors of excessive response to ovarian hyperstimulation .
Moreover , both tests appear to have clinical value .