Uterine fibroids are a common benign gynecologic tumor. In the reproductive age, about 30% of women have fibroids. Can fibroids affect pregnancy? The answer is quite certain: fibroids do not usually affect pregnancy, otherwise close to 1/3 of women of childbearing age have fibroids, but the prevalence of infertility is 8-10% of the population, and about 1/3 of infertile families have a purely male factor. In other words: very few women develop fibroids to the point where they have to have surgery or other treatments to get pregnant. What kind of fibroids require treatment (surgery) before pregnancy? For the average woman, surgery is needed only if there are symptoms that affect the quality of life, such as heavy menstrual flow, incomplete menstruation, or even anemia, or if the fibroids are more than 5 cm in diameter. For women with fibroids that are trying to conceive and are experiencing obstacles to pregnancy, a gynecological pelvic examination and ultrasound are needed to carefully screen for fibroids of different sizes, shapes and numbers in different locations of the uterus. There is no set standard, everything varies from person to person. The first case: when the couple sat in the consultation room, they had already seen several major hospitals locally and abroad. The case was relatively simple – there was 1 fibroid on the uterus, the diameter was already close to 5cm – some doctors in other hospitals said they needed to cut the uterus, some said the fibroid should be removed. And the couple wanted to have another child. This female patient usually has no abnormal menstruation. We doctors know this: real-time scans of different sections of ultrasound can tell us a lot of information that is not visible on the ultrasound graphic report. So, I went to the ultrasound to see where the fibroid was located in the uterus. It was a myoma the size of a mango located in the middle of the posterior wall of the uterus, and most of it was protruding outside the uterus. Only a small part of the tumor invaded the superficial myometrium, i.e. if the myometrium is compared to a wall, the tumor, an unwanted guest, mostly resides outside the wall. The result of the examination and consultation: I told the couple two opinions: this fibroid will not affect the pregnancy. The fibroid can still be observed regularly and if it gets bigger quickly in the short term or if there is discomfort, it must be re-evaluated to consider surgery if necessary. Luckily, a few months later this woman became pregnant, and during the pregnancy we kept an eye on and monitored the changes in that fibroid, which grew much larger in late pregnancy – not surprisingly. When labor was imminent, the husband asked: Do I need a cesarean? Recalling the dynamic images under the ultrasound, I told the couple that the tumor alone was not a reason for a cesarean delivery, which later resulted in the delivery of a boy, who is now, 7 years old. The mother, on the other hand, has not had surgery to date because her estrogen levels are not what they were when she was young and her fibroids have gotten smaller as she is past her forties. Another female patient, too, has been struggling to remove her fibroids with surgery, which have been with her for 5 years, but has been infertile for 3 years. Under our vaginal ultrasound observation, we found a fibroid located behind the endocervix, too small, only 2 cm in diameter, and the only symptom was that her menstrual period always dripped and did not clear easily. Because the tumor was so small, as far as the principle of surgery was concerned, the doctors in the past did not recommend her to have surgery – no doubt there was nothing wrong. We tried and failed to enter her uterine cavity from different directions with a 1mm diameter uterine probe, while a thinner, soft silicone tube could enter, suggesting that she could obtain a pregnancy by artificial insemination. However, her husband did not know why she could not receive assisted reproductive technology at that time. So, we performed a transvaginal myomectomy, which was very small and short, and the tumor was the size of a small lychee when it was removed. The pregnancy was delivered after a year of post-operative contraception – this is a medical history from more than 10 years ago. Therefore, it is important to emphasize that fibroids do not usually affect pregnancy, but women who are pregnant with fibroids and experience barriers to pregnancy need to be carefully screened by a doctor to determine whether they need to be treated for fibroids of different sizes, shapes and numbers in different locations in the uterus.