ABSTRACT Key Content Fibroids are a common gynaecological finding affecting women of reproductive age; the prevalence is as high as 70% with risk factors including increasing age and ethnicity. There is epidemiological evidence linking fibroids to infertility, with fibroids being present in 5%–10% of subfertile women and are estimated to be solely responsible for infertility in 2%–3% of patients. The fibroid location, size and number influence reproductive outcome and should be taken into consideration when offering treatment. Current approaches include non‐surgical therapies including medical therapies and surgical–myomectomy (open, laparoscopic and hysteroscopic excision). This review aims to address how best to manage patients with fibroids with fertility aspirations, including an algorithm for evidence‐based management. Learning Objectives To be able to classify fibroids and appreciate their effect on fertility. To identify fertility patients with fibroids who may benefit from surgical intervention. To learn the effect of myomectomy and other management options on reproductive outcomes.
