***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 The aim of this r and omized controlled trial ( RCT ) was to investigate whether IVF outcomes would differ between patients with POR who received three different gonadotropin doses with or without the addition of  letrozole during ovulation stimulation . STUDY DESIGN Only those who fulfilled two of the three Bologna criteria were included to the study . 95 patients met the inclusion criteria and agreed to participate in the study . In the first group , 31 patients were treated with 450IU gonadotropins . In the second group , 31 patients were treated with 300IU gonadotropins . The third group comprised 33 patients and was treated with 150IU gonadotropins in combination with letrozole . RESULTS The results indicate that differences in doses of hMG and rFSH in patients with POR result in a similar number of retrieved MII and fertilized oocytes , similar fertilization rates , number of transferred embryos , implantation , cancelation , chemical , clinical , and ongoing pregnancy rates . CONCLUSIONS Increasing the dose of gonadotropins during ovulation stimulation is an intuitively appealing approach when the patient is a poor responder . However , increasing the dose does not necessarily improve the reproductive outcome . Using a mild stimulation with addition of letrozole was as effective as stimulation with higher doses of gonadotropins alone in this patient population This study has analysed the relationship between ovarian response and the number of euploid embryos . This is a post hoc analysis of a subset of data generated during a prospect i ve cohort study previously published . Forty-six oocyte donors were subjected to ovarian stimulation with 150 IU of rFSH and 75 IU of hp-hMG in a GnRH agonist long protocol .  Preimplantation genetic screening was performed in all viable embryos . We observed a positive relationship between ovarian response and the number of euploid embryos . When ovarian response was above the median ( ≥17 oocytes ) , the mean number of euploid embryos per donor was 5.0 ± 2.4 , while when < 17 oocytes were obtained the mean number of euploid embryos was 2.7 ± 1.4 ( p = 0.000 ) . Aneuploidy rate did not increase with ovarian response or gonadotropin doses . Also , the number of euploid embryos was inversely related to the amount of gonadotropins needed per oocyte obtained ( ovarian sensitivity index ) . These results suggest that the number of euploid embryos available for embryo transfer increases as the number of oocytes obtained does . Considering the total number of euploid embryos seems more relevant than the aneuploidy rate STUDY QUESTION Are cumulative live birth rates ( CLBRs ) similar in GnRH-antagonist and GnRH-agonist protocol s for the first ART cycle including all subsequent frozen-thaw cycles from the same oocyte retrieval ? SUMMARY ANSWER The chances of at least one live birth following utilization of all fresh and frozen embryos after the first ART cycle are similar in GnRH-antagonist and GnRH-agonist protocol s. WHAT IS KNOWN ALREADY Reproductive outcomes of ART treatment are traditionally reported as pregnancies per cycle or per embryo transfer . However , the primary concern is the overall chance of a live birth . After the first ART cycle with fresh embryo transfer , we found live birth rates ( LBRs ) of 22.8 % and 23.8 % ( P = 0.70 ) for the GnRH-antagonist and GnRH-agonist protocol s , respectively . But with CLBRs including both fresh and frozen embryos from the first oocyte retrieval , chances of at least one live birth increases . There are no previous r and omized controlled trials ( RCTs ) comparing CLBRs in GnRH-antagonist versus GnRH-agonist protocol s. Previous studies on CLBR are either retrospective cohort studies including multiple fresh cycles or RCTs comparing single embryo transfer ( SET ) with double embryo transfer ( DET ) . STUDY DESIGN , SIZE , DURATION CLBR was a secondary outcome in a Phase IV , dual-center , open-label , RCT including 1050 women allocated to a short GnRH-antagonist or a long GnRH-agonist protocol in a 1:1 ratio over a 5-year period using a web-based concealed r and omization code . The minimum follow-up time from the first IVF cycle was 2 years . The aim was to compare CLBR between the two groups following utilization of all fresh and frozen embryos from the first ART cycle . PARTICIPANTS / MATERIAL S , SETTING , METHODS All women referred for their first ART cycle at two public fertility clinics , < 40 years of age were approached . A total of 1050 subjects were allocated to treatment and 1023 women started st and ardized ART protocol s  with recombinant human follitropin-β ( rFSH ) stimulation . Day-2 SET was planned and additional embryos were frozen and used in subsequent frozen-thawed cycles . All pregnancies generated from oocyte retrieval during the first IVF cycle including fresh and frozen-thaw cycles were registered . Ongoing pregnancy was determined by ultrasonography at gestational week 7 - 9 and live birth was irrespective of the duration of gestation . CLBR was defined as at least one live birth per allocated woman after fresh and frozen cycles . Subjects were censored out after the first live birth . Cox proportional hazard model was used to evaluate the relative prognostic significance of female age , BMI , the number of retrieved oocytes and the diagnosis of infertility in relation to the CLBR . MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics were similar and equal proportions of patients continued with frozen-thaw ( frozen embryo transfer , FET ) cycles after their fresh ART cycle in the GnRH-antagonist and GnRH-agonist arms . When combining all fresh and frozen-thaw embryo transfers from first oocyte retrieval with a minimum of 2-year follow-up , the CLBR was 34.1 % ( 182/534 ) in the GnRH-antagonist group versus 31.2 % ( 161/516 ) in the GnRH-agonist group ( odds ratio (OR):1.14 ; 95 % CI : 0.88 - 1.48 , P = 0.32 ) . Mean time to the first live birth was 11.0 months in the GnRH-antagonist group compared to 11.5 months in the GnRH-agonist group ( P < 0.01 ) . The total number of deliveries from all FET cycles where embryos were thawed were higher in the antagonist group 64/330 ( 19.4 % ) compared to the agonist group 43/355 ( 12.1 % ) ( ( OR ) : 1.74 ; 95 % CI : 1.14 - 2.66 , P = 0.01 ) . The evaluation of prognostic factors showed that more retrieved oocytes were associated with a significantly higher CLBR in both treatment groups . For the subgroup of obese women ( BMI > 30 kg/m2 ) , the CLBR was significantly higher in the GnRH-antagonist group ( P = 0.02 ) . LIMITATIONS , REASONS FOR CAUTION The duration of the trial is a possible limitation with introduction of new methods as ' Freeze all ' and ' GnRH-agonist triggering ' , but as these treatments were used in only few women , a systematic bias is not likely . Blastocyst culture of surplus embryos for freezing was introduced to both groups simultaneously , thereby minimizing the risk of bias . Furthermore , with a minimum of 2-year follow-up , a minority ( < 1 % ) still had cryopreserved embryos and no live birth at the end of the trial . The post hoc prognostic covariate analyses with multiple strata should be interpreted with caution . Finally , the physicians were not blinded to GnRH treatment group after r and omization . WIDER IMPLICATION S OF THE FINDINGS With the improvement of embryo culture , freezing and thawing methods as well as a strategy of elective SET , CLBR until first live birth provides an all-inclusive success rate for ART . When comparing GnRH-antagonist and GnRH-agonist protocol s , we find similar CLBRs , despite more oocytes being retrieved in the GnRH-agonist protocol . STUDY FUNDING /COMPETING INTERESTS An unrestricted research grant is funded by Merck Sharp & Dohme Corp. , a subsidiary of Merck & Co. , Inc. , Kenilworth , NJ , USA ( MSD ) . The funders had no influence on the data collection , analyses or conclusions of the study . No conflict of interests to declare . TRIAL REGISTRATION NUMBER EudraCT # : 2008 - 005452 - 24 . Clinical Trial.gov : NCT00756028 . TRIAL REGISTRATION DATE 18 September 2008 . DATE OF FIRST PATIENT 'S ENROLLMENT 14 January 2009 OBJECTIVE To evaluate the dose-response relationship of a novel recombinant human FSH ( rhFSH ; FE 999049 ) with respect to ovarian response in patients undergoing IVF/intracytoplasmic sperm injection treatment ; and prospect ively study the influence of initial antimüllerian hormone ( AMH ) concentrations . DESIGN R and omized , controlled , assessor-blinded , AMH-stratified ( low : 5.0 - 14.9 pmol/L [ 0.7-<2.1 ng/mL ] ; high : 15.0 - 44.9 pmol/L [ 2.1 - 6.3 ng/mL ] ) trial . SETTING Seven infertility centers in four countries . PATIENT(S ) Two hundred sixty-five women aged ≤37 years . INTERVENTION(S ) Controlled ovarian stimulation with either 5.2 , 6.9 , 8.6 , 10.3 , or 12.1 μg of rhFSH , or 11 μg ( 150 IU ) of follitropin alfa in a GnRH antagonist cycle . MAIN OUTCOME MEASURE(S ) Number of oocytes retrieved . RESULT ( S ) The number of oocytes retrieved increased in an rhFSH dose-dependent manner , from 5.2 ± 3.3 oocytes with 5.2 μg/d to 12.2 ± 5.9 with 12.1 μg/d . The slopes of the rhFSH dose-response curves differed significantly between the two AMH strata , demonstrating that a 10 % increase in dose result ed in 0.5 ( 95 % confidence interval 0.2 - 0.7 ) and 1.0 ( 95 % confidence interval 0.7 - 1.3 ) more oocytes in the low and high AMH stratum , respectively . Fertilization rate and blastocyst/oocyte ratio decreased significantly with increasing rhFSH doses in both AMH strata . No linear relationship was observed between rhFSH dose and number of blastocysts overall or by AMH strata . Five cases of ovarian hyperstimulation syndrome were reported for the three highest rhFSH doses and in the high AMH stratum . CONCLUSION ( S ) Increasing rhFSH doses results in a linear increase in number of oocytes retrieved in an AMH-dependent manner . The availability of blastocysts is less influenced by the rhFSH dose and AMH level . CLINICAL TRIAL REGISTRATION NUMBER NCT01426386 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 o 
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The effect estimates were very imprecise , and increased FSH dosing may or may not have an impact on rates of live birth/ongoing pregnancy , OHSS , and clinical pregnancy .
These results should be treated cautiously due to heterogeneity in the study design s. AUTHORS ' CONCLUSIONS We did not find that tailoring the FSH dose in any particular ORT population ( low , normal , high ORT ) , influenced rates of live birth/ongoing pregnancy but we could not rule out differences , due to sample size limitations .
In predicted high responders , lower doses of FSH seemed to reduce the overall incidence of moderate and severe OHSS .
Moderate- quality evidence suggests that ORT-based individualisation produces similar live birth/ongoing pregnancy rates to a policy of giving all women 150 IU .
Further , ORT algorithms reduced the incidence of OHSS compared to st and ard dosing of 150 IU , probably by facilitating dose reductions in women with a predicted high response .
Current evidence does not provide a clear justification for adjusting the st and ard dose of 150 IU in the case of poor or normal responders , especially as increased dose is generally associated with greater total FSH dose and therefore greater cost .
However , a decreased dose in predicted high responders may reduce OHSS