Leiomyomas are the commonest benign tumor in the female reproductive tract. Even though their role on infertility is still questionable, evidence to date suggest that the anatomic location may be related to reproductive outcomes. Several possible mechanisms suggest that leiomyomas may affect fertility, especially in terms of the anatomical distortion of endometrial cavity, the abnormal uterine contractility, reduced blood supply to the endometrium and altered endometrial receptivity. The effect of leiomyomas on IVF outcomes has been the subject of many studies; however, a definitive direction is yet required to adjust clinical management accordingly. Management of leiomyomas is challenging in terms of clinical decision, especially among subfertile patients, since potential treatment complications and their consequences in endometrial dynamics should be also accounted. Expectant management is recommended for asymptomatic patients, whereas in symptomatic subfertile patients, medical and/ or surgical management is usually recommended.