Fibroids occur in many young patients and are common in the reproductive years, so many patients are dealing with fertility issues. First of all, symptomatic fibroids, such as excessive menstrual flow, anemia or pressure, need to be considered regardless of whether a pregnancy is planned or not. This is where we discuss the management of asymptomatic fibroids. From the results of past studies, the chance of spontaneous abortion is increased in people with fibroids compared to those without fibroids, and the clinical pregnancy rate, live birth rate, and the rate of implantation after embryo transfer are probably reduced, but there is no difference in the rate of preterm delivery after pregnancy. One study showed that the live birth rate was 92.4% in pregnancies without fibroids, 92.0% in pregnancies with one fibroid, and 76.4% in pregnancies with two or more fibroids. When the different sites of myomas are treated differently, it can be seen that submucosal myomas affect the clinical pregnancy rate, embryo implantation rate, live birth rate and increase the chance of spontaneous abortion. After surgical removal of submucosal fibroids, these indicators can be significantly improved, especially when looking at the live birth rate, which increases from 3.8% to 63.2% and decreases from 61.6% to 26.3% after surgery. Looking at fibroids that do not affect the morphology of the uterine cavity, the results of several studies pooled together showed no effect on clinical pregnancy rates, but patients with fibroids had an increased incidence of spontaneous abortion, a decreased rate of implantation after embryo transfer, and a decreased rate of live births, but there was no difference in the incidence of preterm birth. When the group of interstitial myomas is further subdivided, all interstitial myomas have an adverse effect, with decreased clinical pregnancy rate, increased spontaneous abortion, decreased implantation rate after embryo transfer, and decreased live birth rate. Since interstitial myomas have an adverse effect on pregnancy, the next question asks whether surgery would improve it. From the few retrospective studies concluded so far, the benefit of surgery was modest and did not reduce the incidence of spontaneous abortion or improve the clinical live birth rate, but since the studies were not high-quality prospective studies, this conclusion is less reliable and more prospective studies are needed to obtain reliable conclusions. Again, the question of what complications can result from fibroids during pregnancy to pregnancy if left untreated. In past studies, it is usually asymptomatic. About 10-30% of patients with fibroids develop various problems during pregnancy, some of them develop pressure symptoms during pregnancy, leading to frequent urination or urinary retention. 5-15% of patients develop pain during pregnancy, usually due to red degeneration of fibroids, but red degeneration does not mean that miscarriage occurs, and most of Most of the patients can be relieved with conservative treatment and the pregnancy is maintained until full term. Other problems include increased risk of abnormal fetal position, placenta praevia, placental abruption, premature rupture of membranes, and postpartum hemorrhage due to fibroids, and submucosal fibroids that can compress the uterine cavity and cause some long-headed malformations and oblique cervical problems in the fetus. Therefore, overall, the occurrence of problems during pregnancy is not a certainty. To conclude, at present, for submucosal myomas before pregnancy we do recommend that they must be treated surgically, not only to improve the uterine cavity environment, reduce the rate of miscarriage and increase the rate of live births, but also to reduce the incidence of fetal malformations. In the case of ectopic subplasmacytic myomas, if there are no symptoms, pregnancy with tumor can be attempted directly. In the case of interstitial myomas, there is no definitive answer as to whether they should be treated before pregnancy or not requires more research. At this point, it does not matter how interventional management measures or not are right or wrong, patients should be encouraged to participate in clinical studies to draw further conclusions. Regardless of the site of the fibroid, if pregnancy has not occurred for more than 1 year, it is possible to consider subuterine surgery to remove the fibroid and to examine both the morphology of the uterine cavity and the condition of the fallopian tubes before trying to conceive. If there is a history of poor pregnancy, such as miscarriage or preterm delivery in the middle of pregnancy, it is also possible to consider treating the fibroids before the next pregnancy. Studies have found that in cases of early miscarriage, myoma removal does not reduce the incidence of the next miscarriage, which may be related to the poor quality of the embryo itself that is the main cause of early miscarriage. At present, for asymptomatic fibroids found during pregnancy, we usually perform transvaginal ultrasound or MRI to find out the type of fibroids, and if the fibroids are type 0, 1, or 2, we usually consider hysteroscopic surgery. If the tumor is less than 4 cm, try direct pregnancy with tumor. If it is more than 4 cm, communicate fully with the patient, talk clearly about the pros and cons, give different treatment options such as pregnancy with tumor, laparoscopic or negative or open surgery or focused ultrasound treatment, and encourage the patient to enter clinical trials. However, if there is no recent requirement for childbirth, there is no hurry to deal with it, as it faces the problem of recurrence after treatment, and generally to deal with it is recommended to be 1 year before pregnancy. With regard to the question of whether uterine fibroids require open surgery if pregnancy is planned, there are prospective studies that state that laparoscopic surgery is not a contraindication for infertile patients if the operator has sufficient experience with lumpectively placed sutures. The specific type of surgery to be considered for each patient also requires a combination of findings, site and number of fibroids, hospital conditions, and surgeon experience. In this article, I have used more data charts to illustrate the problem, maybe some readers may not be able to understand the data, but medicine has entered the stage of evidence-based medicine, using data to speak instead of individual or institutional experience is the future direction, as little as possible to use “so-and-so” authority to say, but research data to say, is the future of the doctor necessary This is a must for doctors in the future. The data I have listed here is only to increase the scientific nature of the recommendations, and I hope I can read it without disturbing you.
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