Table 1. Characteristics of Included Studies.

QoL: quality of life; L: large; S: small; USS: uterus sparing surgery; LM: laparoscopic myomectomy; FV: fibroid volume; USg-HIFU: ultrasound guided high intensity-focused ultrasound

Author Name	Study design	Technique used	Outcome of interest	Result
Jindal et al [20]	Retrospective study, 167 patients	USgHIFU	Fibroid volume (FV), SSS, QoL	Reduction in FV 68% and 75% at 6,12 months, improved QoL, SSS; P < 0.001
Lyon et al. [21]	Observational study, 12 patients	USgHIFU	FV, QoL, Complications, SSS	Reduction in FV 51.9 ± 11.1 %, standard deviation (SD), SSS 40.6 ± 32.7 SD, at 24 months (p < 0.005)
Chen et al. [22]	Multicentre cohort study, 2411 patients 1353 (HIFU)	USgHIFU	Complications, return to normal activities, hospital stay, QoL	Complications 02%, QoL improved; P = 0.001 at 6 months, hospital stay median time 8 days (interquartile range, 7–10 days).
Liu et al. [23]	Comparative study 166 patients	USgHIFU and LM	Efficacy, complication, and QoL between two techniques	Efficacy (P > 0.05), QoL same for two groups, lesser complication in HIFU patients
Liu et al. [24]	Comparative study, 188 women	USgHIFU and secondary myomectomy	Symptom alleviation, re-intervention, adverse effects	Fewer adverse events in the HIFU ablation group P = 0.01, cumulative risk for re-intervention after HIFU ablation is lower compared to myomectomy
He et al. [25]	Retrospective study, 81 women	USgHIFU	Shrinkage rate, symptom relief, QoL	Average volume reduction rate of fibroids 52.5 ± 36.3%, six months after HIFU, Decreased UFS score, and increased QoL
Jiang et al. [26]	Retrospective study, 346 patients	USgHIFU and LM	Compare Pregnancy Outcomes in uterine fibroids patients	Shorter pregnancy interval for HIFU compared to LM 10 months VS. 13 months, p
Wu et al. [27]	Comparative study, 676 patients	USgHIFU and LM	Pregnancy Outcomes in uterine fibroid patients	68.4% of women became pregnant after USgHIFU and 66.7% after LM, rate of cesarean delivery was lower in the USgHIFU group at 41.6% (p < 0.05)
Jeng et al. [28]	Retrospective study, 500 patients	USg-HIFU	FV, QoL, pregnancy Outcomes, Adverse effects	Lesion size reduced by 40.2% after 3 months of HIFU, QoL improved, and pregnancy was reported in 12 patients
Vincent et al. et.al [29]	Prospective study, 20 patients	USg-HIFU	FV, QoL, Adverse effects	FV reduction was 46.9 (range -8.8-73.1) at 1 month, UFS-QOL scores were reduced by 40.7% at 3 months; no complications encountered
Wang et al. [30]	Retrospective comparative study, 245 patients	USg-HIFU and Uterus Sparing Surgery (USS)	Clinical outcomes like recurrence rate, QoL, complications	symptom relief rate was 95.9% for HIFU, decreased recurrence rate for HIFU compared to USS, no major complications noted in HIFU
Lee et al. [31]	Clinical trial, 36 patients	USg-HIFU	FV, symptom improvement, QoL, safety	Mean FV reduction was 45.1% at 5 months after HIFU treatment, Symptoms and QoL improved after HIFU, with no complications related to symptoms and safety.
Ren et al. [32]	Comparative study, 587 patients	USg-HIFU and LM	Safety and clinical efficacy	Intra-operative blood loss is reduced in the HIFU group, with lower complications than LM group; FV decreased significantly at 12 months p < 0.05
Chang et al. [33]	Retrospective study, 107 patients	USg-HIFU	FV, QoL, symptoms in patients of large (L) and small (S) Fibroid	Significant reduction in FV in L and S group but higher in S group  p < 0.05, improved QoL in both groups