human
***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 To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy ( ART ) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture . DESIGN Prospect i ve r and omized study . SETTING Fertility center . PATIENT(S ) After giving informed consent , 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through r and om selection : embryo transfer with acupuncture ( n = 80 ) and embryo transfer without acupuncture ( n = 80 ) . INTERVENTION(S ) Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer . In the control group , embryos were transferred without any supportive therapy . MAIN OUTCOME MEASURE(S ) Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer . RESULT ( S ) Clinical pregnancies were documented in 34 of 80 patients ( 42.5 % ) in the acupuncture group , whereas pregnancy rate was only 26.3 % ( 21 out of 80 patients ) in the control group . CONCLUSION ( S ) Acupuncture seems to be a useful tool for improving pregnancy rate after ART OBJECTIVE To replicate previous research on the efficacy of acupuncture in increasing pregnancy rates ( PR ) in patients undergoing IVF and to determine whether such an increase was due to a placebo effect . DESIGN Prospect i ve , r and omized , controlled , single blind trial . SETTING Private , academically affiliated , infertility clinic . PATIENT(S ) One hundred fifty patients scheduled to undergo embryo transfer . INTERVENTION(S ) Subjects were r and omized to either the acupuncture or control group . Acupuncture patients received the protocol , as first described by Paulus and his colleagues , for 25 minutes before and after embryo transfer . Control subjects laid quietly . All subjects then completed question naires on anxiety and optimism . The IVF staff remained blind to subject assignment . MAIN OUTCOME MEASURE(S ) Clinical PRs , anxiety , optimism . RESULT ( S ) Before r and omization both groups had similar demographic characteristics including age and psychological variables . There were no significant differences in PRs between the two groups . Acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects . CONCLUSION ( S ) The use of acupuncture in patients undergoing IVF was not associated with an increase in PRs but they were more relaxed and more optimistic Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome ( PCOS ) . Our aim was to investigate whether acupuncture affects ovulation frequency and to underst and the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS . This prospect i ve , r and omized , controlled clinical trial was conducted between June 2009 and September 2010 . Thirty-two women with PCOS were r and omized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 - 13 wk . Main outcome measures were changes in LH secretion patterns from baseline to after 10 - 13 wk of treatment and ovulation frequency during the treatment period . Secondary outcomes were changes in the secretion of sex steroids , anti-Müllerian hormone , inhibin B , and serum cortisol . Ovulation frequency during treatment was higher in the acupuncture group than in the control group . After 10 - 13 wk of intervention , circulating levels of estrone , estrone sulfate , estradiol , dehydroepi and rosterone , dehydroepi and rosterone sulfate , and rostenedione , testosterone , free testosterone , dihydrotestosterone , and rosterone glucuronide , and rostane-3α,17β-diol-3-glucuronide , and and rostane-3α,17β-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except and rostenedione . We conclude that repeated acupuncture treatments result ed in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist . Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion BACKGROUND In a previous study on the effect of electro-acupuncture ( EA ) in combination with a paracervical block ( PCB ) as an analgesic method during oocyte aspiration in IVF treatment , EA appeared to increase the pregnancy rate . This study was design ed to test the hypothesis that EA as an analgesic during oocyte aspiration would result in : ( i ) a better IVF pregnancy rate than with alfentanil ; ( ii ) peroperative analgesia that was as good as that produced by alfentanil ; ( iii ) less postoperative abdominal pain , nausea and stress ; and ( iv ) a reduction in the use of additional analgesics . Neuropeptide Y ( NPY ) concentrations in follicular fluid ( FF ) were analysed when possible . METHODS AND RESULTS In this prospect i ve , r and omized , multicentre clinical trial , 286 women undergoing oocyte aspiration were r and omly allocated to the EA group ( EA plus a PCB ) or to the alfentanil group ( alfentanil plus a PCB ) . No significant differences were found between the EA and alfentanil groups in any of the IVF variables . NPY concentrations in FF were significantly higher in the EA group compared with the alfentanil group . No correlation between pregnancy rate and NPY concentrations was found in either analgesic group . Both EA plus a PCB and alfentanil plus a PCB induced adequate peroperative analgesia during oocyte aspiration evaluated using the visual analogue scale . After 2 h , the EA group reported significantly less abdominal pain , other pain , nausea and stress than the alfentanil group . In addition , the EA group received significantly lower amounts of additional alfentanil than the alfentanil group . CONCLUSION EA does not improve pregnancy rate in the present clinical situation . The observation that NPY concentrations in FF were higher in the EA group may be important for human ovarian steroidogenesis . The analgesic effects produced by EA are as good as those produced by conventional analgesics , and the use of opiate analgesics with EA is lower than when conventional analgesics alone are used To which groups of patients can the results of clinical trials be applied ? This question is often inappropriately answered by reference to the trial entry criteria . Instead , the benefit and harm ( adverse events , discomfort of treatment , etc ) of treatment could be assessed separately for individual patients . Patients at greatest risk of a disease will have the greatest net benefit as benefit to patients usually increases with risk while harm remains comparatively fixed . To assess net benefit , the relative risks should come from ( a meta- analysis of ) r and omised trials ; the risk in individual patients should come from multivariate risk equations derived from cohort studies . However , before making firm conclusions , the assumptions of fixed adverse effects and constant reduction in relative risk need to be checked OBJECTIVE To evaluate the influence of " true " versus " sham " acupuncture on pregnancy rates ( PRs ) in women undergoing IVF . DESIGN R and omized controlled trial , double-blinded with independent observer . SETTING Academic infertility clinic . PATIENT(S ) One hundred sixty patients < 38 years old undergoing IVF with or without intracytoplasmic sperm injection . INTERVENTION(S ) Subjects were r and omly allocated to the true or sham group and underwent acupuncture 25 minutes before and after ET . Subjects completed a McGill Pain Question naire regarding their clinical symptoms during ET . MAIN OUTCOME MEASURE(S ) Clinical PR and clinical symptoms during ET . RESULT ( S ) While the overall clinical PR was 51.25 % , there was no significant difference between the arms of the study ( true = 45.3 % vs. sham = 52.7 % ) ; 33.1 % of the patients had ultrasound-documented singleton pregnancy , and 15 % of patients had twin gestations , while one patient in the true arm had a triplet gestation . There were significant differences in the subjective , affective , and total pain experience between both arms . The subjects in the true arm described their acupuncture session as being more " tiring " and " fearful " and experienced more " achiness " compared with their sham counterparts . CONCLUSION ( S ) There was no statistically significant difference in the clinical or chemical PRs between both groups . Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm . There were no significant adverse effects observed during the study , suggesting that acupuncture is safe for women undergoing ET OBJECTIVE To determine the effect of luteal-phase acupuncture on the outcome of  IVF/intracytoplasmic sperm injection ( ICSI ) . DESIGN R and omized , prospect i ve , controlled clinical study . SETTING University IVF center . PATIENT(S ) Two hundred twenty-five infertile patients undergoing IVF/ICSI . INTERVENTION(S ) In group I , 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine . In group II , 109 patients received placebo acupuncture . MAIN OUTCOME MEASURE(S ) Clinical and ongoing pregnancy rates . RESULT ( S ) In group I , the clinical pregnancy rate and ongoing pregnancy rate ( 33.6 % and 28.4 % , respectively ) were significantly higher than in group II ( 15.6 % and 13.8 % ) . CONCLUSION ( S ) Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI Purpose To determine if acupuncture improves symptoms of anxiety in infertile women undergoing in vitro fertilisation ( IVF ) treatment . Methods A r and omised clinical trial was performed in 43 patients undergoing IVF . The patients were r and omised into two groups : test group ( n=22 ) and control group ( n=21 ) . The anxiety level of each patient was analysed before and after treatment using the Hamilton Anxiety Rating Scale ( HAS ) . Treatment sessions consisted of four weekly sessions . In the test group , needles were inserted at points HT7 , PC6 , CV17 , GV20 and Yintang . In the control group , needles were inserted in areas near but not corresponding to acupuncture points . Results The mean HAS score after the 4-week experimental period was significantly lower in the test group than in the control group ( 19.4±3.2 vs 24.4±4.2 ; p=0.0008 ) . Conclusions The results indicate that acupuncture can reduce anxiety symptoms observed by the reduction of psychological parameters of women undergoing IVF . Further evidence should be sought as to whether acupuncture might be a complementary option for patients undergoing IVF Background Different mechanisms have been described for the effects of acupuncture on fertility . Acupuncture may mediate neurotransmitter release , which results in the stimulation of gonadotrophin-releasing hormone secretion . The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response . Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity . Despite some evidence suggesting beneficial effects of acupuncture on in vitro fertilisation ( IVF ) success rates , recent clinical trials could not duplicate these effects , especially in patients who are infertile with polycystic ovarian syndrome ( PCOS ) who are undergoing IVF . Methods A total of 62 women with PCOS undergoing IVF/intracytoplasmic sperm injection ( ICSI ) at Shayamehr IVF Clinic in Tehran ( Iran ) participated in a r and omised , controlled trial . Participants were r and omly allocated to one of two groups : there were 31 women each in the acupuncture ( group I ) and control groups ( group II ) . Acupuncture based on traditional Chinese medicine was performed in group I versus no adjunctive treatment in group II . All acupuncture procedures were performed in five sessions : start of downregulation , start of stimulation , 2 days before ovum pick-up , and immediately before and after embryo transfer . We measured the rate of oocytes in metaphase II , the fertilisation rate and the quality of embryos . Results Our results showed a statistically higher mean of good quality embryos in group I compared with group II ( p=0.044 ) . However , the mean number of metaphase II oocytes retrieved and fertilisation rate were similar between the two groups . We also could not find any significant differences among clinical , biochemical or ongoing pregnancy rates . Conclusions Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality . However , it seems to have no significant effect on other IVF/ICSI outcomes of women with PCOS . Trial Registration Number ( I RCT ID : 201011275181N4 Background : To evaluate the safety of acupuncture in a large number of patients receiving conventional health care and , based on these results , to develop a new medical consent form for acupuncture . Methods : The prospect i ve observational study included patients who received acupuncture treatment for chronic osteoarthritis pain of the knee or hip , low back pain , neck pain or headache , allergic rhinitis , asthma , or dysmenorrhoea . After treatment , all patients documented adverse events associated with acupuncture ( defined as ad 
    Output:
    
agent
***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 To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy ( ART ) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture . DESIGN Prospect i ve r and omized study . SETTING Fertility center . PATIENT(S ) After giving informed consent , 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through r and om selection : embryo transfer with acupuncture ( n = 80 ) and embryo transfer without acupuncture ( n = 80 ) . INTERVENTION(S ) Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer . In the control group , embryos were transferred without any supportive therapy . MAIN OUTCOME MEASURE(S ) Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer . RESULT ( S ) Clinical pregnancies were documented in 34 of 80 patients ( 42.5 % ) in the acupuncture group , whereas pregnancy rate was only 26.3 % ( 21 out of 80 patients ) in the control group . CONCLUSION ( S ) Acupuncture seems to be a useful tool for improving pregnancy rate after ART OBJECTIVE To replicate previous research on the efficacy of acupuncture in increasing pregnancy rates ( PR ) in patients undergoing IVF and to determine whether such an increase was due to a placebo effect . DESIGN Prospect i ve , r and omized , controlled , single blind trial . SETTING Private , academically affiliated , infertility clinic . PATIENT(S ) One hundred fifty patients scheduled to undergo embryo transfer . INTERVENTION(S ) Subjects were r and omized to either the acupuncture or control group . Acupuncture patients received the protocol , as first described by Paulus and his colleagues , for 25 minutes before and after embryo transfer . Control subjects laid quietly . All subjects then completed question naires on anxiety and optimism . The IVF staff remained blind to subject assignment . MAIN OUTCOME MEASURE(S ) Clinical PRs , anxiety , optimism . RESULT ( S ) Before r and omization both groups had similar demographic characteristics including age and psychological variables . There were no significant differences in PRs between the two groups . Acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects . CONCLUSION ( S ) The use of acupuncture in patients undergoing IVF was not associated with an increase in PRs but they were more relaxed and more optimistic Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome ( PCOS ) . Our aim was to investigate whether acupuncture affects ovulation frequency and to underst and the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS . This prospect i ve , r and omized , controlled clinical trial was conducted between June 2009 and September 2010 . Thirty-two women with PCOS were r and omized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 - 13 wk . Main outcome measures were changes in LH secretion patterns from baseline to after 10 - 13 wk of treatment and ovulation frequency during the treatment period . Secondary outcomes were changes in the secretion of sex steroids , anti-Müllerian hormone , inhibin B , and serum cortisol . Ovulation frequency during treatment was higher in the acupuncture group than in the control group . After 10 - 13 wk of intervention , circulating levels of estrone , estrone sulfate , estradiol , dehydroepi and rosterone , dehydroepi and rosterone sulfate , and rostenedione , testosterone , free testosterone , dihydrotestosterone , and rosterone glucuronide , and rostane-3α,17β-diol-3-glucuronide , and and rostane-3α,17β-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except and rostenedione . We conclude that repeated acupuncture treatments result ed in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist . Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion BACKGROUND In a previous study on the effect of electro-acupuncture ( EA ) in combination with a paracervical block ( PCB ) as an analgesic method during oocyte aspiration in IVF treatment , EA appeared to increase the pregnancy rate . This study was design ed to test the hypothesis that EA as an analgesic during oocyte aspiration would result in : ( i ) a better IVF pregnancy rate than with alfentanil ; ( ii ) peroperative analgesia that was as good as that produced by alfentanil ; ( iii ) less postoperative abdominal pain , nausea and stress ; and ( iv ) a reduction in the use of additional analgesics . Neuropeptide Y ( NPY ) concentrations in follicular fluid ( FF ) were analysed when possible . METHODS AND RESULTS In this prospect i ve , r and omized , multicentre clinical trial , 286 women undergoing oocyte aspiration were r and omly allocated to the EA group ( EA plus a PCB ) or to the alfentanil group ( alfentanil plus a PCB ) . No significant differences were found between the EA and alfentanil groups in any of the IVF variables . NPY concentrations in FF were significantly higher in the EA group compared with the alfentanil group . No correlation between pregnancy rate and NPY concentrations was found in either analgesic group . Both EA plus a PCB and alfentanil plus a PCB induced adequate peroperative analgesia during oocyte aspiration evaluated using the visual analogue scale . After 2 h , the EA group reported significantly less abdominal pain , other pain , nausea and stress than the alfentanil group . In addition , the EA group received significantly lower amounts of additional alfentanil than the alfentanil group . CONCLUSION EA does not improve pregnancy rate in the present clinical situation . The observation that NPY concentrations in FF were higher in the EA group may be important for human ovarian steroidogenesis . The analgesic effects produced by EA are as good as those produced by conventional analgesics , and the use of opiate analgesics with EA is lower than when conventional analgesics alone are used To which groups of patients can the results of clinical trials be applied ? This question is often inappropriately answered by reference to the trial entry criteria . Instead , the benefit and harm ( adverse events , discomfort of treatment , etc ) of treatment could be assessed separately for individual patients . Patients at greatest risk of a disease will have the greatest net benefit as benefit to patients usually increases with risk while harm remains comparatively fixed . To assess net benefit , the relative risks should come from ( a meta- analysis of ) r and omised trials ; the risk in individual patients should come from multivariate risk equations derived from cohort studies . However , before making firm conclusions , the assumptions of fixed adverse effects and constant reduction in relative risk need to be checked OBJECTIVE To evaluate the influence of " true " versus " sham " acupuncture on pregnancy rates ( PRs ) in women undergoing IVF . DESIGN R and omized controlled trial , double-blinded with independent observer . SETTING Academic infertility clinic . PATIENT(S ) One hundred sixty patients < 38 years old undergoing IVF with or without intracytoplasmic sperm injection . INTERVENTION(S ) Subjects were r and omly allocated to the true or sham group and underwent acupuncture 25 minutes before and after ET . Subjects completed a McGill Pain Question naire regarding their clinical symptoms during ET . MAIN OUTCOME MEASURE(S ) Clinical PR and clinical symptoms during ET . RESULT ( S ) While the overall clinical PR was 51.25 % , there was no significant difference between the arms of the study ( true = 45.3 % vs. sham = 52.7 % ) ; 33.1 % of the patients had ultrasound-documented singleton pregnancy , and 15 % of patients had twin gestations , while one patient in the true arm had a triplet gestation . There were significant differences in the subjective , affective , and total pain experience between both arms . The subjects in the true arm described their acupuncture session as being more " tiring " and " fearful " and experienced more " achiness " compared with their sham counterparts . CONCLUSION ( S ) There was no statistically significant difference in the clinical or chemical PRs between both groups . Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm . There were no significant adverse effects observed during the study , suggesting that acupuncture is safe for women undergoing ET OBJECTIVE To determine the effect of luteal-phase acupuncture on the outcome of  IVF/intracytoplasmic sperm injection ( ICSI ) . DESIGN R and omized , prospect i ve , controlled clinical study . SETTING University IVF center . PATIENT(S ) Two hundred twenty-five infertile patients undergoing IVF/ICSI . INTERVENTION(S ) In group I , 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine . In group II , 109 patients received placebo acupuncture . MAIN OUTCOME MEASURE(S ) Clinical and ongoing pregnancy rates . RESULT ( S ) In group I , the clinical pregnancy rate and ongoing pregnancy rate ( 33.6 % and 28.4 % , respectively ) were significantly higher than in group II ( 15.6 % and 13.8 % ) . CONCLUSION ( S ) Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI Purpose To determine if acupuncture improves symptoms of anxiety in infertile women undergoing in vitro fertilisation ( IVF ) treatment . Methods A r and omised clinical trial was performed in 43 patients undergoing IVF . The patients were r and omised into two groups : test group ( n=22 ) and control group ( n=21 ) . The anxiety level of each patient was analysed before and after treatment using the Hamilton Anxiety Rating Scale ( HAS ) . Treatment sessions consisted of four weekly sessions . In the test group , needles were inserted at points HT7 , PC6 , CV17 , GV20 and Yintang . In the control group , needles were inserted in areas near but not corresponding to acupuncture points . Results The mean HAS score after the 4-week experimental period was significantly lower in the test group than in the control group ( 19.4±3.2 vs 24.4±4.2 ; p=0.0008 ) . Conclusions The results indicate that acupuncture can reduce anxiety symptoms observed by the reduction of psychological parameters of women undergoing IVF . Further evidence should be sought as to whether acupuncture might be a complementary option for patients undergoing IVF Background Different mechanisms have been described for the effects of acupuncture on fertility . Acupuncture may mediate neurotransmitter release , which results in the stimulation of gonadotrophin-releasing hormone secretion . The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response . Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity . Despite some evidence suggesting beneficial effects of acupuncture on in vitro fertilisation ( IVF ) success rates , recent clinical trials could not duplicate these effects , especially in patients who are infertile with polycystic ovarian syndrome ( PCOS ) who are undergoing IVF . Methods A total of 62 women with PCOS undergoing IVF/intracytoplasmic sperm injection ( ICSI ) at Shayamehr IVF Clinic in Tehran ( Iran ) participated in a r and omised , controlled trial . Participants were r and omly allocated to one of two groups : there were 31 women each in the acupuncture ( group I ) and control groups ( group II ) . Acupuncture based on traditional Chinese medicine was performed in group I versus no adjunctive treatment in group II . All acupuncture procedures were performed in five sessions : start of downregulation , start of stimulation , 2 days before ovum pick-up , and immediately before and after embryo transfer . We measured the rate of oocytes in metaphase II , the fertilisation rate and the quality of embryos . Results Our results showed a statistically higher mean of good quality embryos in group I compared with group II ( p=0.044 ) . However , the mean number of metaphase II oocytes retrieved and fertilisation rate were similar between the two groups . We also could not find any significant differences among clinical , biochemical or ongoing pregnancy rates . Conclusions Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality . However , it seems to have no significant effect on other IVF/ICSI outcomes of women with PCOS . Trial Registration Number ( I RCT ID : 201011275181N4 Background : To evaluate the safety of acupuncture in a large number of patients receiving conventional health care and , based on these results , to develop a new medical consent form for acupuncture . Methods : The prospect i ve observational study included patients who received acupuncture treatment for chronic osteoarthritis pain of the knee or hip , low back pain , neck pain or headache , allergic rhinitis , asthma , or dysmenorrhoea . After treatment , all patients documented adverse events associated with acupuncture ( defined as ad 
    Output:
    