”Doctor, I have fibroids, they have been growing for a few years, now they are 7cm and I am preparing to have children, should I operate or observe? “This is a question that I often get in my clinic. Today, I would like to focus on answering it. I have written an article on “Pregnancy-related problems with fibroids”, in which I have basically answered the question of when fibroids should be considered for treatment before pregnancy and when to treat them. Today’s article focuses on how to deal with it. If the fibroids are type 0, 1 or 2, submucosal fibroids that affect the morphology of the uterine cavity, they should be treated 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 current patients with fertility requirements are operated laparoscopically, and open surgery is only considered when the fibroids are too large and the number of tumors is excessive. Focused ultrasound technology (HEF) 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 same way, and the energy introduced into the body will heat and ablate the protein in the tumor, and the tumor will shrink and absorb after the operation. The disadvantage is that the treatment is not like open or laparoscopic surgery, where the tumor is removed, but only by heating and necrosis, 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, and although many patients have become pregnant after treatment, a definite conclusion has not yet been reached. 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 this choice. Uterine artery embolization for fibroids is also a common option abroad, but studies suggest that in cases of fertility, the chances of conception with arterial embolization are only half of those with surgical treatment, so uterine artery embolization should not be used as a preconception treatment for fibroids. The following question, mentioned in passing, is when to treat them if at all before conception. Fibroids are a hormone-dependent disease and may recur as long as menstruation occurs. Therefore, if you have no symptoms and are not planning to have a baby, there is no need to rush to have surgery, and the evaluation should be done 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 ranging 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.