***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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    ***EXAMPLES*** 
    Input: BACKGROUND The relationship between fibroids and infertility remains a critical and unresolved question . During the implantation phase , it is known that uterine peristalsis is dramatically reduced , which is thought to facilitate implantation of the embryo to the endometrium . In the previous study , using a cine MRI mode , we found that less than half of the patients with intramural fibroids exhibited abnormal uterine peristalsis during the mid-luteal phase . In the present study , we further investigated whether myomectomy for patients in the high peristalsis group is a constructive method to normalize uterine peristalsis . METHODS The frequency of junctional zone movement was evaluated using a cine MRI mode during the mid-luteal phase . Fifteen infertility patients , who had intramural myomas and exhibited abnormal uterine peristalsis ( ≥2 times/3 min ) in their first MRI , underwent myomectomy and a second MRI . After receiving the second MRI , patients underwent infertility treatment for at least 8 months , and pregnancy rate was evaluated prospect ively . RESULTS Among 15 patients , the frequency of uterine peristalsis was normalized ( 0 or 1 time/3 min ) in 14 patients . Following myomectomy and second MRI test , 6 of the 15 patients achieved pregnancy ( n = 15 , pregnancy rate : 40 % ) . CONCLUSIONS The presence of uterine fibroids might induce abnormal uterine peristalsis in some patients , leading to infertility , and myomectomy may improve fertility in these patients OBJECTIVE To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive . DESIGN R and omized controlled trial . SETTING Departments of obstetrics and gynecology of the universities of Catanzaro , Rome , and Florence , Italy . PATIENT(S ) One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility . INTERVENTION(S ) Laparoscopic and minilaparotomic myomectomy . MAIN OUTCOME MEASURE(S ) Pregnancy , abortion , and live-birth rates . RESULT ( S ) Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy , live-birth , and abortion rates , whereas pregnancy and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group . Categorizing the patients according to surgical indication for myomectomy , cumulative pregnancy rate , pregnancy , and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients , whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility . CONCLUSION ( S ) Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility , whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas OBJECTIVE : To assess the severity of symptoms caused by uterine leiomyomas , their effect on health-related quality of life , and the change after treatment compared with a normal control group . METHODS : A multicenter nonr and omized prospect i ve study was completed assessing 12-month outcomes from three leiomyoma treatments . Outcome measures included the Uterine Fibroid Symptom and Quality of Life and the Short Form 36 question naires .  Women scheduled for hysterectomy , myomectomy , or uterine artery embolization were recruited , as well as normal control group members . Question naires were completed at baseline and at 6 and 12 months posttreatment . Baseline characteristics were summarized using descriptive statistics . General linear models were used to examine differences among the patient groups . RESULTS : A total of 375 patients completed baseline enrollment : 101 normal , 107 embolization , 61 myomectomy , and 106 hysterectomy .  At baseline , the mean Uterine Fibroid Symptom and Quality of Life Symptom Severity score for women in the normal control group was 15.3 ( ±14.5 ) and 64.8 ( ±20 ) for the leiomyoma patients ( P<.001 ) . At 6 and 12 months , the mean Symptom score for women in the normal control group was unchanged , while the leiomyoma treatment group score reduced to a mean of 17.8 ( ±17.5 ) at 12 months . Similar magnitude changes occurred among the Uterine Fibroid Symptom and Quality of Life health-related quality of life subscale scores for the normal control group members and leiomyoma patients . At 12 months , the hysterectomy group reported significantly lower symptoms and better health-related quality of life than the other two therapies ( P<.001 ) . CONCLUSION : At 12 months after treatment , all three leiomyoma therapies result ed in substantial symptom relief , to near normal levels , with the greatest improvement after hysterectomy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00390494 . LEVEL OF EVIDENCE : OBJECTIVES To examine total pregnancy rate , pregnancy rate in relation to pretreatment with GnRH-analogues , the frequency of myoma recurrencies and the influence of size , number and localization of removed myomata on pregnancy rate and outcome in infertility patients after myomectomy .  STUDY DESIGN A comparative , retrospective non-r and omized clinical study involving 67 patients with desire for children and no other recognizable infertility factor .  Myomectomy had been performed between 1985 and 1993 . Most patients had been operated by laparotomy using microsurgical instruments and techniques . Thirty-three patients had been treated with a GnRH agonist for usually 3 months , and in 34 patients the operation was performed without pretreatment . Patients were followed up to June , 1994 . All patients were mailed a question naire and invited to an ultrasound examination . RESULTS Thirty-nine of the 67 patients ( 58.2 % ) became pregnant , and a total of 51 pregnancies were observed . Of the women who actually conceived , 61.5 % did so within the first year . There was no significant difference in pregnancy rates between patients who had been pretreated with GnRH agonists and those who had not . However , 1 year after the operation the group of GnRH-treated women was significantly overrepresented among those already pregnant ( P = 0.02 ) . Sonografical examination revealed in 31 out of the 67 patients ( 46.3 % ) recurrent myomata > 1 cm in diameter . There was no statistically significant difference in the pregnancy rates between patients with and without recurrencies . However , there was a significant tendency toward a loss or short duration of the pregnancy due to spontaneous abortion and premature delivery in patients with recurrent or persistent myomata ( P < 0.01 ) . Pregnancy rate was significantly lower in patients with more than five myomata removed ( P < 0.001 ) . In the group with a larger myoma volume the pregnancy rate was significantly higher than in the group with the smaller one ( P < 0.01 ) , possibly indicating that the size on removal of myomata is an important factor for infertility patients . Concerning the localization of the removed myomata , no statistically significant difference was found in the pregnancy rates between various localizations . Of the 51 pregnancies , 31 ( 60.8 % ) led to a delivery , vaginal in 13 cases ( 41.9 % ) and 18 times by Caesarean section ( 58.1 % ) . Of the pregnancies that were lost , 39.2 % were due to spontaneous abortion or ectopic pregnancy . CONCLUSIONS Our study supports reports on the benefits of myomectomy , performed with the appropriate technique , in patients with otherwise unknown cause of infertility . It shows , additionally , that characteristics of myomata , such as number and size , may influence postmyomectomy pregnancy rates This prospect i ve , controlled study was performed in order to evaluate whether the location of uterine fibroids may influence reproductive function in women and whether removal of the fibroid prior to conception may improve pregnancy rate and pregnancy maintenance . We examined 181 women affected by uterine fibroids who had been trying to conceive for at least 1 year without success . The main outcome measures were the pregnancy rate and the miscarriage rate . Among the patients who underwent myomectomy  , the pregnancy rates obtained were 43.3 % in cases of submucosal , 56.5 % in cases of intramural , 40.0 % in cases of submucosal – intramural and 35.5 % in cases of intramural – subserosal uterine fibroids , respectively . Among the patients who did not undergo surgical treatment , the pregnancy rates obtained were 27.2 % in women with submucosal , 41.0 % in women with intramural , 15.0 % in women with submucosal – intramural and 21.43 % in women with intramural – subserosal uterine fibroids , respectively . Although the results were not statistically significant in the group of women with intramural and intramural – subserosal fibroids , this study confirms the important role of the position of the uterine fibroid in infertility as well as the importance of fibroids removal before the achievement of a pregnancy , to improve both the chances of fertilization and pregnancy maintenance BACKGROUND To determine the optimal surgical approach for laparoscopic uterine artery ligation ( LUAL ) combined with myomectomy in the management of women with symptomatic uterine fibroids . METHODS This is a prospect i ve study . One hundred and six women with symptomatic uterine myomas underwent LUAL + laparoscopic morcellation after enucleation ( enucleation group ) ( n = 51 ) or LUAL + laparoscopic in situ morcellation ( ISM group ) ( n = 55 ) . The outcome was measured by comparing surgical techniques , symptom control , recurrence and pregnancy during a 3-year follow-up in both groups . RESULTS General characteristics of the patients were similar in both groups , except the myomas were larger in the ISM group . The operative time ( mean ± SD ) was significantly shorter in the ISM group than the enucleation group ( 107 ± 30 min versus 128 ± 49 min , P = 0.009 ) . There were no differences in the therapeutic outcomes of the two groups at the 3-year follow-up , with low recurrence rates and good symptom control rates . Of the sexually active patients without contraception , the pregnancy and live birth rates were 87.5 and 100 % in the ISM group and 66.7 and 83.3 % in the enucleation group ( all NS ) . CONCLUSIONS The LUAL + myomectomy , either by enucleation or ISM , is acceptable in the management of symptomatic uterine fibroids . However , the LUAL + ISM technique might be more feasible , as it requires less operative time OBJECTIVE To determine the effects of hysteroscopic myomectomy on  menorrhagia and infertility  and the influence of intramural extension on surgical feasibility and long-term outcomes . METHODS We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated ( n = 54 ) , sessile ( n = 30 ) , or intramural ( n = 24 ) leiomyomas over 7 years at an academic department specializing in endoscopic surgery . RESULTS The mean ( + /- st and ard deviation ) operating time and distension medium deficit were 18+/-7 minutes and 204+/-276 mL in the pedunculated lesion group , 23+/-9 minutes and 278+/-269 mL in the sessile lesion group , and 32+/-8 minutes and 335+/-272 mL in the intramural lesion group , respectively . More than one procedure was required to complete myoma removal in 14 ( 26 % ) of 54 , eight ( 26 % ) of 30 , and 12 ( 50 % ) of 24 subjects in the pedunculated , sessile , and intramural lesion groups , respectively . After a mean follow-up of 41 months , myomas recurred in 27 subjects , with a 3-year cumulative rate of 34 % . Twenty women had recurrent menorrhagia , with a 3-year cumulative probability of 30 % . The 3-year cumulative probability of conception was 49 % in women with pedunculated lesions , 36 % in those with sessile lesions , and 33 % in those with intramural lesions . The study had 80 % power to detect five- and three-fold increases in menorrhagia recurrence and conception rates , respectively , in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group . CONCLUSION Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence , but the benefit for infertility was less impressive . Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal OBJECTIVE To determine whether hysteroscopic myomectomy for submucous fibroids in women with 
    Output:
    
There is currently insufficient evidence from r and omised controlled trials to evaluate the role of myomectomy to improve fertility .
Regarding the surgical approach to myomectomy , current evidence from two r and omised controlled trials suggests there is no significant difference between the laparoscopic and open approach regarding fertility performance .
Finally , there is currently no evidence from r and omised controlled trials regarding the effect of hysteroscopic myomectomy on fertility outcomes