Uterine myomas are heterogeneous tumors in composition, size, location, and number; variation in any of these factors could possibly alter the effect on a woman's fertility status. The effect of myomas on fertility has been the subject of many studies. However, a definitive answer is still missing. The location and size of the myomas are the two parameters that influence the success of a future pregnancy. Subserosal myomas seem to have little effect on reproductive outcome. Myomas that compress the uterine cavity with an intramural portion and submucosal myomas significantly reduce pregnancy rates, and should be removed before assisted reproductive techniques are performed. Patients with intramural myomas also may have a poorer reproductive outcome, but the lacks of quality evaluations make this conclusion tenuous at best. Removal of myomas with an intra-cavitary component seems to be of benefit. However there are as yet no data to support myomectomy in the treatment of intramural myomas to improve fertility outcomes. Treatment modality for myomas located at intramural sites should be determined according to clinical status of the patient and doctor's experience.