***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 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 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 ongoing pregnancy rates were significantly reduced : 23.3 , 11.9 and 15.1 respectively compared with 34.1 , 20.2 and 28.3 % in the control group ( P = 0.016 , P = 0.018 and P = 0.003 ) . The mean size of the largest fibroids was 2.3 cm ( 90 % range 2.1 - 2.5 cm ) . Logistic regression analysis demonstrated that the presence of intramural fibroids was one of the significant variables affecting the chance of an ongoing pregnancy , even after controlling for the number of embryos available for replacement and increasing age , particularly age > or = 40 years , odds ratio 0.46 ( CI 0.24 - 0.88 ; P = 0.019 ) . CONCLUSION This study demonstrated that an intramural fibroid halves the chances of an ongoing pregnancy following assisted conception 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 Twenty to fifty per cent of women are estimated to have fibroids , and the incidence increases with age until menopause.1 Whether fibroids cause infertility is the subject of considerable speculation ; fibroids are estimated to be the sole cause of infertility in less than 3 % of cases.2 The impression that fibroids contribute to infertility has arisen from several case series , mostly without controls , where a varying proportion of previously infertile women conceived after their fibroids had been removed.3 4 However , case series are generally not considered strong evidence of causation , so whether fibroids do cause infertility , and therefore whether they should be removed , is still uncertain.5 A systematic review of 22 observational studies and one r and omised controlled trial has recently reported reduced fertility in women with fibroids , mostly in association with assisted reproductive technology cycles.6 The review suggests that the location of the fibroids may matter : women with subserosal fibroids do not seem to be less fertile than women with no fibroids ; however , women with submucosal fibroids ( with or without intramural fibroids ) had decreased fertility and increased pregnancy loss compared with women with no fibroids . There are several reasons to be 
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These findings highlight the current deficiency in the literature and suggest that evidence is insufficient to draw any conclusions regarding the effect of intramural fibroids on reproductive outcomes