There is an ongoing debate about the effect of leiomyomata on reproductive outcome. The absence of randomized controlled trials is the main reason why this hot topic has been still actual. Generally, based on the available literature, it may be suggested that leiomyomata may have an adverse effect on both fertility and the surveillance of the pregnancy. Although this deleterious effect is more obvious in the presence of submucous or intramural leiomyomata with distortion of the endometrial cavity, this association is based on more inconclusive data in cases with intramural leiomyomata without endometrial distortion. Therefore, while myomectomy should be recommended more precisely in patients with submucous or intramural leiomyomata with distortion of the endometrial cavity before spontaneous conception or assisted reproduction technologies (ART), there is paucity of data to recommend routine treatment in the remaining cohort of patients. In the current review, the impact of leiomyomata on the reproductive performance has been discussed in terms of patients undergoing ART or attempting spontaneous conception.