Background: Uterine fibroids (UFs) are the most common female benign tumors linked to significant morbidity. There are large literature data connecting UFs with infertility and adverse pregnancy outcome. In this research, authors reviewed literature on UFs, analyzing their relationship with infertility, influence of different therapeutic approaches of UFs on fertility and the possible mechanisms related to UFs and infertility. Methods: MEDLINE and PubMed search, during the years 1990–2020 was performed using a combination of keywords on such topic. Peer-reviewed, systematic review, meta-analysis and prospective trials, examining relationship between UFs and infertility were included in this investigation. According to authors evaluation, additional articles were also identified from the retrieved papers references and included in this narrative review. Results: UFs, especially the submucous and intramural types, with related treatments are linked to impairment of fertility and adverse pregnancy outcome, but many data are conflicting. Molecular mechanisms investigations could explain relationship between UFs and infertility. Conclusion: UFs are linked to infertility and interventions improve fertility. However, many studies conflict in the final results, so further investigations on UFs and infertility should clarify the exact role of molecular mechanisms of this association.