***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: BACKGROUND Several studies have reported that the presence of intramural fibroids affects conception following IVF . We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies . METHODS Women with small intramural leiomyomata ( < or = 5 cm ) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospect ively matched by age , with the next patient of the same age undergoing IVF who did not demonstrate fibroids ( controls ) . RESULTS Though no significant differences were found in outcome when comparing these two groups , there was a distinct trend for lower live delivery rates and higher miscarriage rates . CONCLUSIONS These data support the conclusions of the only other prospect i ve matched control study evaluating similar factors , i.e. that small intramural fibroids can negatively affect IVF outcome . Nevertheless , we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not Uterine leiomyomata ( fibroids ) are the leading cause of hysterectomy in the United States . Black women have a greater fibroid burden than whites , yet no study has systematic ally evaluated the growth of fibroids in blacks and whites . We prospect ively tracked growth for 262 fibroids ( size range : 1–13 cm in diameter ) from 72 premenopausal participants ( 38 blacks and 34 whites ) .  Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months . We used mixed effects models to identify factors that are associated with growth , and results were converted to percent change per 6 months for clinical relevance . The median growth rate was 9 % ( range : −89 % to + 138 % ) . Seven percent of fibroids regressed ( > 20 % shrinkage ) . Tumors from the same woman grew at different rates ( within-woman component of variation was twice the component among women ; both were significant , P < 0.001 ) . Black and white women less than 35 years of age had similar fibroid growth rates . However , growth rates declined with age for whites but not for blacks ( P = 0.05 ) . The odds of a tumor growing more than 20 % in 6 months also decreased with age for whites but not for blacks ( P < 0.01 ) . Growth rates were not influenced by tumor size , location , body mass index , or parity . We conclude that ( i ) spontaneous regression of fibroids occurs ; ( ii ) fibroids from the same woman grow at different rates , despite a uniform hormonal milieu ; ( iii ) fibroid size does not predict growth rate ; and ( iv ) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women We sought to determine the relationship of fibroids to  pregnancy loss in a prospect i ve cohort in which fibroid status was uniformly documented in early pregnancy . Participants had an intake interview , transvaginal ultrasonography , computer-assisted telephone interview , and follow-up assessment of outcomes . We recruited diverse participants for the Right From the Start study from 8 metropolitan areas in 3 states in the United States during 2000 - 2012 . Participants were at least 18 years of age , trying to become pregnant or at less than 12 weeks ' gestation , not using fertility treatments , fluent in English or Spanish , and available for telephone interviews .  Miscarriage was defined as loss before 20 weeks ' gestation . Fibroid presence , number , type , and volume were assessed using st and ardized ultrasonography methods . We used proportional hazards models to estimate associations . Among 5,512 participants , 10.4 % had at least 1 fibroid , and 10.8 % experienced a miscarriage . Twenty-three percent had experienced a prior miscarriage and 52 % prior births . Presence of fibroids was associated with miscarriage in models without adjustments . Adjusting for key confounders indicated no increase in risk ( adjusted hazard ratio = 0.83 , 95 % confidence interval : 0.63 , 1.08 ) . No characteristic of fibroids was associated with risk . Prior evidence attributing miscarriage to fibroids is potentially biased . These findings imply that surgical removal of fibroids to reduce risk of miscarriage deserves careful scrutiny 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 : BACKGROUND There is no consensus as to whether uterine fibroids have any adverse effects on the outcomes of assisted reproduction treatment . This prospect i ve study compared implantation/pregnancy rates of women with and without fibroids undergoing IVF-embryo transfer  and measured uterine blood flow indices of the fibroid group . METHODS Patients who had fibroids that , during transvaginal scanning , were found to be not distorting the endometrial lining were placed in the fibroid group , while patients with normal uteri were controls . Those with previous myomectomy or pedunculated subserosal fibroids only were excluded . All received a st and ard ovarian stimulation regimen . Doppler ultrasound examinations of uterine arteries were carried out in the fibroid group prior to oocyte retrieval . RESULTS Similar implantation/pregnancy rates , multiple pregnancy rates and pregnancy outcomes were noted in both groups . In the fibroid group , significantly lower pulsatility index ( PI ) and resistance index ( RI ) of the right uterine artery and the average of right and left uterine arteries were found in those failing to conceive than in those patients who subsequently conceived ( P < 0.001 ) . CONCLUSION The presence of fibroids not distorting the endometrial lining does not adversely affect implantation and pregnancy rates during IVF-embryo transfer . Significantly lower uterine artery PI and RI were found in non-pregnant women with fibroids than in their pregnant counterparts BACKGROUND The impact of intramural fibroids on the success of IVF treatment is controversial and the mechanisms leading to poor treatment outcomes remain unknown . We compared endometrial and subendometrial blood flow between women with and without intramural fibroids during IVF treatment . METHODS Three-dimensional ( 3D ) ultrasound examination with power Doppler was performed on the day of oocyte retrieval in 50 patients with intramural fibroids not distorting the uterine cavity and in 50 matched controls to measure endometrial thickness , uterine pulsatility index (PI)/resistance index ( RI ) , endometrial volume and vascularization index (VI)/flow index (FI)/vascularization flow index ( VFI ) of endometrial and subendometrial regions .  Smokers , patients with serum estradiol concentrations > or = 20,000 pmol/l on the day of HCG and previous history of myomectomy were excluded . RESULTS Endometrial thickness and pattern , averaged uterine PI and RI and endometrial and subendometrial VI/FI/VFI were similar between the fibroid group and the control group . There was no correlation between the total volume of fibroids and endometrial and subendometrial 3D power Doppler flow indices in the fibroid group . CONCLUSION Endometrial and subendometrial 3D power Doppler flow indices were similar in patients with and without small intramural fibroids OBJECTIVE Uterine leiomyoma , or fibroid tumors , are the leading indication for hysterectomy in the United States , but the proportion of women in whom fibroid tumors develop is not known . This study screened for fibroid tumors , independently of clinical symptoms , to estimate the age-specific proportion of black and white women in whom fibroid tumors develop . STUDY DESIGN R and omly selected members of an urban health plan who were 35 to 49 years old participated ( n = 1364 women ) .  Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating ( most of whom had had hysterectomies ) . Premenopausal women were screened by ultrasonography . We estimated the age-specific cumulative incidence of fibroid tumors for black and white women . RESULTS Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors . Fifty-one percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors . The estimated cumulative incidence of tumors by age 50 was > 80 % for black women and nearly 70 % for white women . The difference between the age-specific cumulative incidence curves for black and white women was highly significant ( odds ratio , 2.9 ; 95 % CI , 2.5 - 3.4 ; P < .001 ) . CONCLUSION The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women BACKGROUND Although uterine fibroids occur in 30 % of women and are associated with a degree of subfertility , the effect of intramural fibroids on the outcome of IVF or ICSI treatment has not been prospect ively studied . METHODS Data were prospect ively collected on 434 women undergoing IVF/ICSI in the assisted conception unit of an inner London teaching hospital . Patients were assessed for the presence of fibroids by transvaginal ultrasound and hysterosonography or hysteroscopy where appropriate . RESULTS During the study period , 112 women with ( study ) , and 322 women without ( controls ) , intramural fibroids were treated . Patients were similar regarding the cause and duration of their infertility , number of previous treatments , and basal serum FSH concentration .  Women in the study group were on average 2 years older ( 36.4 versus 34.6 years ; P < 0.01 ) . There was no significant difference in the duration of ovarian stimulation or gonadotrophin requirement , number of follicles developed , oocytes collected , embryos available for transfer or replaced . When analysing only women with intramural fibroids of < or = 5 cm in size ( n = 106 ) pregnancy , implantation and on 
    Output:
    
There is insufficient evidence to conclude that the presence of myomas reduces the likelihood of achieving pregnancy .
However , there is fair evidence that myomectomy ( open or laparoscopic ) for cavity-distorting myomas ( intramural or intramural with a submucosal component ) improves pregnancy rates and reduces the risk of early pregnancy loss .
There is fair evidence that hysteroscopic myomectomy for cavity-distorting myomas improves clinical pregnancy rates but insufficient evidence regarding the impact of this procedure on the likelihood of live birth or early pregnancy loss .
In women with asymptomatic cavity-distorting myomas , myomectomy may be considered to optimize pregnancy outcomes