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ABSTRACT Key Content Submucosal fibroids have the most impact on fertility, while subserosal fibroids do not generally affect fertility. The effect of intramural fibroids on fertility is uncertain. For clinicians caring for women with infertility, the decision for if, and when, to intervene to treat fibroids can be complicated, especially for intramural fibroids. Treatment decisions depend on the type, location and size of the fibroid(s), as well as the age of the woman, cause of infertility and reproductive history. The main treatment options are hysteroscopic, laparoscopic and open myomectomy. The impact of fibroids on fertility has long been debated. In some women, fibroids may contribute to infertility, reduce the success rates of assisted reproductive techniques and lead to pregnancy complications. Black women have a higher prevalence of fibroids and face worse outcomes from fertility treatment. Addressing these disparities through earlier referrals is crucial. Learning Objectives To determine a safe framework for the management of fibroids in women of reproductive age. To review the management of fibroids in the context of infertility. To discuss how improving the management of fibroids may help to reduce racial inequality in access to, and success of, assisted reproductive techniques.