This is a problem that I often encounter in my gynecology clinic and I would like to state my opinion here. Uterine fibroids are a common disease in young women, and according to my statistics of the incidence of 700,000 people, it is probably evident that fibroids are still a frequent problem for many women of childbearing age. This is a typical case of a 33-year-old woman who found fibroids 4 years ago during a checkup, and has been asymptomatic. Some doctors recommend surgery, while others recommend pregnancy with tumor. Different doctors have different recommendations, so the patient is confused. To answer such a question, I probably still need to elaborate on the issue of clinical thinking. Modern medicine is increasingly talking about the concept of evidence-based medicine, and what is evidence-based is the need to find a comparative study for the treatment of a disease. To answer a similar question, modern medicine usually needs to design a clinical study on the same population, for example, 1000 patients with the same 5cm interstitial myxoma, randomized (note: not according to the opinion or request of the doctor or the patient, but by a method like throwing a ball to decide which group the patient goes to), half of the patients get pregnant with the tumor, half of the patients have surgery, and then after 5 years Once we have the results of such a study, we will have an answer to the question of which is right or wrong. Of course, one study is often not enough, need to do studies in different places, different populations, so that all the results of the study together to reach a summary analysis (scientific name also called “meta-analysis”) of the conclusions, once there is such a conclusion, the patient will have the answer when asking the doctor. Unfortunately, there are no such studies available! The reality is that most patients ask if there are any such randomized controlled studies, and once they are asked if they would like to be randomized to a study, many are reluctant (in fact, this is not being a guinea pig, but participating in a study before an answer is available is also helpful to others, and participation in clinical research is considered a treatment measure in the NCCN oncology guidelines). In the absence of randomized controlled studies, then what the doctor can do is to tell you the pros and cons of the known treatment options, and then the doctor and the patient can discuss the treatment options together or make decisions based on experience, but of course such treatment may not always be seen as the best, because at this time neither the doctor nor the patient knows where the truth lies. For the problem of fibroids before pregnancy, all that can be known so far is probably: 1. When pregnant with tumors, fibroids can affect the embryo’s implantation, which will increase the chance of miscarriage, 10-15% chance of red degenerative abdominal pain in early pregnancy, no chance of rupture, and increased risk of postpartum bleeding and abnormal fetal position in late pregnancy; 2. Surgical removal of fibroids will have the risk of surgery-related blood loss and infection, and surgery After the surgery, the uterus has a scar and the next pregnancy has a risk of rupture of 5 per thousand, and the trauma of the uterus after the surgery also tends to form adhesions with the outside, which makes the next surgery difficult, and there is still a problem of recurrence of fibroids after the surgery, and the next pregnancy needs to be considered after 3~12 months of contraception after the surgery; 3, the new treatment method of ultrasound focus therapy (HEF) can make the fibroids lose their blood supply and shrink after the treatment, avoiding the surgery-related trauma. The advantage is that there is no risk of surgical adhesions and recovery is faster. As to which of these 3 options will have a better chance of holding the baby after 5 years, we lack the results of the study, so it is impossible to know. After knowing the pros and cons of these methods, if you are willing to participate in a randomized controlled study, I welcome it, but if not, it is necessary to discuss the next step of treatment with your doctor together. There are some cases where conservative observation of pregnancy with tumor is not advisable, including: 1) already having heavy menstrual flow, pressure on the bladder or rectum; 2) already having infertility, and after screening for other causes of infertility, the only remaining problem is fibroids; 3) submucosal fibroids with pressure on the uterine cavity and a high chance of miscarriage due to submucosal fibroids; 4) if there is a history of a bad pregnancy in the past. The problem of pregnancy miscarriage occurs in the middle or late stages (after the third month of pregnancy). Such cases are more likely to be treated with surgery or HEFI intervention. Another question that is often asked is whether it is better to have minimally invasive surgery or open surgery. There are no results from large samples of studies, and the limited randomized controlled studies suggest that there is no difference between the two groups. Endoscopic surgery is not currently considered a contraindication for patients with fertility requirements.