This chapter outlines the current evidence regarding the effect of fibroids and polyps on fertility, and the effect of various treatments for these pathologies on fertility outcomes. It provides a proposed treatment algorithm to assist reproductive health specialists with management decisions. When faced with a couple with unexplained infertility where the woman has a fibroid uterus, the management is influenced by associated clinical symptoms. Submucosal (SM) and possibly intramural (IM) fibroids have a negative effect on fertility and in vitro fertilization (IVF) outcomes, but it does not necessarily follow that myomectomy improves success, as the influence of uterine scar formation on embryo implantation is unknown. For those patients who are offered myomectomy, a hysteroscopic approach is the treatment of choice for SM fibroids. Uterine artery embolization (UAE) involves radiologically guided embolization of the uterine arteries with the intent of causing ischaemic injury to the fibroid.