Doctor, I have fibroids that have grown for several years and are now 7cm and I am preparing to have children, should I have surgery or observe? This is a question that I often get in my clinic. Today, I would like to focus on the answer. If the fibroids are type 0, 1 or 2, submucosal fibroids that affect the morphology of the uterine cavity, they should be treated in advance before pregnancy. If it is a type 6, 7 or 8 subplasmacytoma, it is probably possible to consider a pregnancy with tumor. Regardless of the type of fibroid, if it becomes symptomatic or if it becomes a cause of infertility or miscarriage, then it should also be considered. The treatment of fibroids is divided into hysteroscopic surgery, laparoscopic surgery, open surgery, cathodic surgery, focused ultrasound (HEF), and arterial embolization. Hysteroscopic surgery is usually suitable for submucosal fibroids of type 0, 1, or 2. Hysteroscopic surgery requires a high level of skill, especially when the number of tumors is high or the size is large; negative surgery is suitable for fibroids that prolapse into the vagina, fibroids in the cervical area, or subplasma fibroids. Open surgery and laparoscopic surgery are commonly used for interstitial or subplasmic fibroids. Open surgery is suitable for almost all patients. The advantage of open surgery is that the operator’s fingers can be felt during the operation, which reduces the chance of missing the fibroids, and the sutures are relatively well controlled, but the open surgery wound is relatively large (the incision depends on the size, location, and number of fibroids, generally speaking, it should be 6-10 cm), painful, and the recovery is slower. Open surgery is a relatively traditional method. Laparoscopic surgery has become a more popular technique in the last 30 years or so. Laparoscopic surgery is suitable for almost all patients except for small submucosal fibroids and more fibroids, and laparoscopic surgery generally uses microscopic incisions in the abdomen (generally 3-4 incisions, length 0.3-1.5 cm). Another disadvantage is that it requires a relatively high level of operator skill and a relatively long learning curve. One of the questions I am usually asked in the clinic is whether I should have open or laparoscopic surgery. To answer this question, I think we still need to see if anyone has done a study on this. Randomized controlled studies are the standard for testing a measure, and there is currently a randomized controlled study done in Italy worldwide that shows no difference between laparoscopic and open surgery. However, many doctors in China are now opposed to the laparoscopic approach, arguing that laparoscopic suturing is not as good as open surgery and that the chance of postoperative rupture is increased. My personal opinion on this issue is that if the surgeon is experienced in laparoscopic surgery and laparoscopic suturing is not a problem (laparoscopic suturing is relatively the most difficult technique to master), then it is not a contraindication for people with fertility requirements, but if the surgeon is just starting to do laparoscopic surgery and suturing is still a difficult task, then open surgery is considered. In fact, most of my patients with fertility requirements are currently undergoing laparoscopic surgery, but only if the fibroids are too large (more than 10 cm) and the number of fibroids is too large (more than 5), then laparoscopic surgery is considered. However, another side effect of medication is that it may make small fibroids even smaller and increase the chance of intraoperative leakage. Focused ultrasound technology (HEF or magnetic wave) is a new technology that has emerged in the last 10 years. The treatment is done by gathering ultrasound waves on the tumor like a solar focal point, so there is no damage in the channel. The disadvantage is that the treatment is not like open or laparoscopic surgery, which can take out the tumor, the tumor can only be heated and necrosed, and in most cases the tumor cannot disappear completely and may grow again during pregnancy. Focused ultrasound has been used in the treatment of fibroids for more than 10 years, but we have not yet accumulated much experience with patients who want to have children, although there are many patients who have become pregnant after treatment, and the FDA has also approved the indications for focused ultrasound treatment of infertile patients this year, but a definite conclusion has not yet been formed. At present, we mainly communicate and explain to patients about this new technology, and if they are willing to accept this new technology, MRI and ultrasound are safe, they are also given the option to do so. Uterine artery embolization for fibroids is also a common option abroad, but studies suggest that the chances of conception with arterial embolization are only half of those with surgical treatment if fertility is required, so uterine artery embolization should not be used as a preconception treatment for fibroids. If the fibroids are to be treated before pregnancy, when should they be treated. Fibroids are a hormone-dependent disease and may recur as long as menstruation comes. Therefore, if you have no symptoms and are not currently planning to have children, you do not need to rush to have surgery, but evaluate it about a year before you plan to get pregnant. In the case of hysteroscopic or hysteroscopic surgery, conception is usually considered 3 months after the surgery, while in the case of open or laparoscopic surgery, there is no definitive answer as to how long it takes to conceive after surgery, usually from 3 to 12 months depending on experience with contraception. There are many unanswered questions in medicine that need to be constantly explored. I hope to support the conclusions in the article I have written with as much objective evidence as possible. I hope that the words herein will answer some of the questions you may have in your clinic.