With the advancement of medical science, the tragedy of uterine fibroids leading to complete loss of fertility is becoming less and less common. However, as fibroids are largely estrogen-dependent tumors, they are a common disease among women of childbearing age. It can be said that the relationship between fibroids and pregnancy and childbirth is inextricable and confusing. Let’s try to sort out the relationship between fibroids and pregnancy from the following aspects. What should I do if I am going to get pregnant but fibroids are found in the examination? The answer to this question requires consideration of many aspects. Generally speaking, if the relationship with pregnancy and childbirth is not considered, only those fibroids that are in an unusual location (described later), present symptoms such as heavy menstrual flow, dripping menstruation, anemia, or have a diameter of more than 5 cm require surgery. In the case of women who are preparing to become pregnant, the indications for treatment should be appropriately wide. For submucosal fibroids located in the uterine cavity, treatment is recommended before pregnancy, regardless of the presence of symptoms (usually excessive menstruation or dysmenorrhea), due to the possibility of preventing the future embryo from implanting. Hysteroscopy is currently considered to be the best approach. It is a minimally invasive procedure (called minimally invasive surgery) in which a special camera lens is placed through the vagina and cervical canal and the procedure is performed with special instruments. The recovery is usually quicker after the procedure because there is no need to make an incision in the abdomen. So, just how big is a fibroid that must be operated on before pregnancy? Unfortunately, there are no clear rules. In clinical practice, some medical units (e.g. Peking Union Medical College Hospital) consider that patients can consider pregnancy if the fibroids do not exceed 4 cm in diameter for interstitial fibroids or subplasma fibroids. However, patients need to be aware that the fibroids may grow rapidly during pregnancy due to the dramatic changes in the blood supply to the uterus, which may occur as a result of ischemia and lead to red degeneration, or as a result of torsion of the subplasmalemma when the uterus changes position. Both conditions may lead to severe abdominal pain and trigger a miscarriage or premature delivery. If the fibroid is located at the lower end of the uterus, i.e. the cervix (sometimes the fibroid is more than 2 cm in diameter), or if the fibroid is larger than 4 cm in diameter elsewhere, or if, despite the fibroid being smaller than 4 cm, the patient has a history of infertility or multiple spontaneous miscarriages and no other clear cause can be found to rule out the fibroid as the culprit, a fibroid removal before pregnancy may also be considered. There are advantages and disadvantages of laparoscopic or open surgery to remove fibroids. How long should I take to prevent pregnancy after myomectomy, assuming it is performed? This is a question that cannot usually be answered before surgery and requires the surgeon’s judgment based on what happens during surgery. In general, if the fibroids are located between the walls of the uterus or under the plasma membrane, if they are few in number, if they do not cause significant damage to the integrity of the wall of the uterus, and if they do not break through the entire layer and enter the uterine cavity, you can prepare for pregnancy after 6 months of postoperative contraception; if the fibroids are many in number, if they open multiple openings in the uterine wall, if they cause significant damage to the integrity of the uterine wall, or if they enter the uterine cavity during removal, or if the removal process is particularly difficult, then it is recommended to Contraception for at least one year or even two years before considering pregnancy. Of course, in the case of subplasmacytic fibroids that are attached to the uterus by a slender tip, if the operation is as easy as picking apples or grapes, with little damage to the integrity of the uterine wall, it is possible to prepare for pregnancy after the first menstrual period, or at most 3 months of contraception.