***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 
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    Input: BACKGROUND Prediction of ovarian response prior to the first controlled ovarian stimulation ( COS ) cycle is useful in determining the optimal starting dose of recombinant FSH ( rFSH ) . However , potentially predictive factors may be subject to inter-cycle variability and many patients are pre-treated with oral contraceptives ( OC ) for scheduling purpose s. Our objective was to determine predictive factors of ovarian response for patients undergoing COS with rFSH in a gonadotrophin-releasing hormone antagonist protocol and to determine the inter-cycle variability of these factors . METHODS In this multinational trial , 442 patients were r and omized to receive either OC treatment or no treatment prior to their first COS cycle . For c and i date predictive factors , patient characteristics were collected at screening , and endocrine and sonographic data were collected during the early follicular phase of the two subsequent cycles . A treatment regimen of 200 IU rFSH and 0.25 mg ganirelix was applied during the second cycle . Predictive factors of ovarian response and of too low ( < 6 oocytes ) or too high ( > 18 oocytes ) ovarian responses were determined using stepwise linear regression and stepwise logistic regression , respectively . RESULTS Anti-Müllerian hormone ( AMH ) and basal FSH were statistically significant predictors of the number of oocytes retrieved and of an excessive ovarian response . For low ovarian response , AMH was the only significant predictive factor . In the non-OC group , the predictive value was higher than in the OC group and higher at the early follicular phase of the stimulation cycle than of the previous cycle . The inter-cycle variation for AMH was low compared with the inter-cycle variation of other hormones . Between the two groups , there were no differences in the number or quality of embryos obtained or transferred , but the implantation rate was significantly lower in the OC group ( 24.1 versus 30.1 % , P= 0.03 ) , result ing in an ongoing pregnancy rate of 26.3 % compared with 35.7 % in the non-OC group ( P= 0.05 ) . CONCLUSIONS The best predictive model of ovarian response was in the non-OC group and included both AMH and basal FSH determined at the early follicular phase of the stimulation cycle . In the proceeding cycle , AMH alone had sufficient predictive value since it was not affected by inter-cycle variability or OC pretreatment Background The overall incidence of poor ovarian response in IVF cycles has been reported to be between 9 and 24 % . The management of these patients remains a significant challenge in assisted reproduction . The aim of the present study was to evaluate the effect of myo-inositol ( MI ) on ovarian function in poor responders undergoing ICSI . Methods The study is a prospect i ve controlled observational trial , that involved 72 poor responders included in an ICSI program and divided into two groups ; group A : 38 patients who have been assuming MI ( 4 g ) + folic acid ( FA ) ( 400 μg ) for the previous 3 months before the enrollment day ; group B : 38 patients assuming FA ( 400 μg ) alone for the same period . COH was carried out in the same manner in the two groups . The main goal was the assessment of oocytes retrieved number and quality ; secondary endpoints were the Ovarian Sensitivity Index ( OSI : n ° oocytes retrieved/total Gonadotropins units × 1000 ) , oestradiol levels on the day of hGC , fertilization rate , implantation rate , ongoing pregnancy rate . Results There was no significant difference between the two groups regarding oestradiol level , but total rec-FSH units were significantly lower ( p = 0.004 ) and M2 oocytes rate significantly higer ( p = 0.01 ) in group A. The ovarian sensitivity index was higher , reaching a statistical significance ( p < 0.05 ) , in the group of patients pre-treated with MI , showing an improvement in ovarian sensibility to gonadotropin . Conclusions Our results suggest that MI therapy in poor responders results in an increased of the number of oocytes recovered in MII  and of the gonadotropin Ovarian Sensitivity Index ( OSI ) , suggesting a MI role in improving ovarian response to gonadotropins . Therefore MI seems to be helpful in “ poor responders ” undergoing IVF cycles Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND The follicular microenvironment is an important determinant of oocyte development . The aim of this study was to examine whether the myo-inositol ( MI ) content in human follicular fluid ( FF ) was associated with better oocyte quality . METHODS A total of 53 patients treated with IVF  was recruited to a prospect i ve observational study . FF and serum sample s collected were divided into two groups : group A consisted of FF associated with matured and fertilized oocytes , whilst group B was from follicles with immature and unfertilized oocytes . RESULTS Patient 's age , total ampoules of HMG used , days of stimulation , basal levels of FSH , estradiol ( E(2 ) ) levels on the day of HCG , and serum MI content were not significantly different between the two groups . FF volume and its MI content were significantly higher in group A compared with group B ( P < 0.05 ) . The levels of MI in FF were positively correlated with the amount of E(2 ) in their corresponding FF sample s and also correlated with embryo quality . CONCLUSIONS We propose that higher concentrations of MI and E(2 ) in human FF appear to play a role in follicular maturity and provide a marker of good quality oocytes We hypothesized that the administration of troglitazone , an insulin-sensitizing agent of the thiazolidinedione class , would improve the ovulatory dysfunction ,  hirsutism  , hyper and rogenemia , and hyperinsulinemia of polycystic ovary syndrome ( PCOS ) patients . Four hundred and ten premenopausal women with PCOS in a multicenter , double blind trial were r and omly assigned to 44 weeks of treatment with placebo ( PBO ) or troglitazone [ 150 mg/day ( TGZ-150 ) , 300 mg/day ( TGZ-300 ) , or 600 mg/day ( TGZ-600 ) ] . We compared changes in ovulatory function ( by monitoring the urinary level of pregnanediol-3-glucuronide daily ) , hirsutism ( by a modified Ferriman-Gallwey scoring method ) , hormonal levels ( total and free testosterone , and rostenedione , sex hormone-binding globulin , LH , FSH , and the LH/FSH ratio ) , and measures of glycemic parameters ( fasting levels of glucose , insulin , hemoglobin A(1c ) , and the glucose and insulin areas under the curve during an oral glucose challenge ) among study groups . Of the 410 patients recruited , 305 ( 74.4 % ) met evaluability criteria and were included in the analyses . The patients ' baseline characteristics were similar across all treatment arms . Ovulatory rates were significantly greater for patients receiving TGZ-300 and TGZ-600 than for those receiving PBO ( 0.42 and 0.58 vs. 0.32 ; P < 0.05 and 0.0001 , respectively ) . Of PCOS patients treated with TGZ-600 , 57 % ovulated over 50 % of the time compared with 12 % of placebo-treated patients . There was a significant decrease in the Ferriman-Gallwey score with TGZ-600 compared with PBO ( 0.22 + /- 0.53 vs. -2.21 + /- 0.49 ; P < 0.05 , respectively ) . Free testosterone decreased and sex hormone-binding globulin increased in a dose-related fashion with troglitazone treatment , and all three troglitazone treatment groups were significantly different from placebo . Nearly all glycemic parameters showed dose-related decreases with troglitazone treatment . The total number and severity of adverse events ( including elevations in liver enzymes ) and the proportion of patients withdrawn from the study due to the development of adverse effects were similar between treatment groups . Troglitazone improves the ovulatory dysfunction , hirsutism , hyper and rogenemia , and insulin resistance of PCOS  in a dose-related fashion , with a minimum of adverse effects OBJECTIVE To determine the effects of myo-inositol on oocyte quality in polycystic ovary syndrome ( PCOS ) patients undergoing intracytoplasmic sperm injection ( ICSI ) cycles . DESIGN A prospect i ve , controlled , r and omized trial . SETTING Assisted reproduction centers . PATIENT(S ) Sixty infertile PCO patients undergoing ovulation induction for ICSI . INTERVENTION(S ) All participants underwent st and ard long protocol . Starting on the day of GnRH administration , 30 participants received myo-inositol combined with folic acid ( Inofolic ) 2 g twice a day and 30 control women received folic acid alone , administrated continuously . MAIN OUTCOME MEASURE(S ) Primary end points were number of morphologically mature oocytes retrieved , embryo quality , and pregnancy and implantation rates . Secondary end points were total number of days of FSH stimulation , total dose of gonadotropin administered , E(2 ) level on the day of hCG administration , fertilization rate per number of retrieved oocytes , embryo cleavage rate , live birth and miscarriage rates , cancellation rate , and incidence of moderate or severe ovarian hyperstimulation syndrome . RESULT ( S ) Total r-FSH units ( 1,958 + /- 695 vs. 2,383 + /- 578 ) and number of days of stimulation ( 11.4 + /- 0.9 vs. 12.4 + /- 1.4 ) were significantly reduced in the myo-inositol group . Furthermore , peak E(2 ) levels ( 2,232 + /- 510 vs. 2,713 + /- 595 pg/mL ) at hCG administration were significantly lower in patients receiving myo-inositol . The mean number of oocytes retrieved did not differ in the two groups , whereas in the group cotreated with myo-inositol the mean number of germinal vesicles and degenerated oocytes was significantly reduced ( 1.0 + /- 0.9 vs. 1.6 + /- 1.0 ) , with a trend for increased percentage of oocytes in metaphase II ( 0.82 + /- 0.11 % vs. 0.75 + /- 0.15 % ) . CONCLUSION ( S ) These data show that in patients with PCOS , treatment with myo-inositol and folic acid , but not folic acid alone , reduces germinal vesicles and degenerated oocytes at ovum pick-up without compromising total number of retrieved oocytes . This approach , reducing E(2 ) levels at hGC administration , could be adopted to decrease the risk of hyperstimulation in such patients Abstract Polycystic ovarian syndrome ( PCOS ) induces anovulation in women of reproductive age , and is one of the pathological factors involved in the failure of in vitro fertilization ( IVF ) . Indeed , PCOS women are characterized by poor quality oocytes . Therefore , a treatment for enhancing oocyte quality becomes crucial for these patients . Myo-Inositol and melatonin proved to be efficient predictors for positive IVF outcomes , correlating with high oocyte quality . We tested the synergistic effect of myo-inositol and melatonin in IVF protocol s with PCOS patients in a r and omized , controlled , double-blind trial . Five-hundred twenty-six PCOS women were divided into three groups : Controls ( only folic acid : 400 mcg ) , Group A ( Inofolic ® plus , a daily dose of myo-inositol : 4000 mg , folic acid : 400 mcg , and melatonin : 3 mg ) , and Group B ( Inofolic ® , a daily dose of myo-inositol : 4000 mg , and folic acid : 400 mcg ) . The main outcome measures were oocyte and embryo quality , clinical pregnancy and implantation rates . The treatment lasted from the first day of the cycle until 14 days after embryo transfer . Myo-inositol and melatonin have shown to enhance , synergistically , oocyte and embryo quality . In consideration of the beneficial effect observed in our trial and on the bases of previous studies , we decided to integrate routinely MI and M supplementation in the IVF protocol s. The same treatment should be taken carefully in consideration in all procedures of this kind BACKGROUND The study aim was to assess whether the incorporation of myo-inositol ( MI ) into culture medium could improve oocyte maturation in vitro . METHODS AND RESULTS We performed a controlled prospect i ve study using female ICR strain mice superovulated with pregnant mare 's serum gonadotrophins . Cumulus-enclosed germinal vesicle ( GV ) oocytes were r and omly cultured in medium with or without MI supplementation . The kinetics of GV breakdown after 4 h of incubation was significantly higher in oocytes incubated with 30 mmol/l of MI than in controls ( P < 0.001 ) . Accordingly , this concentration of MI was used for subsequent experiments . The proportion of 
    Output:
    
Conclusions : Myoinositol supplement  increase clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET .
It may improve the quality of embryos , and reduce the unsuitable oocytes and required amount of stimulation drugs