STUDY OBJECTIVE: To assess the role of leiomyomas and their surgical removal on pregnancy rates. DESIGN: (Canadian Task Force classification II-1). Setting. Academic center. PATIENTS: Two hundred twelve women who were investigated for infertility. INTERVENTION: Laparoscopic myomectomy. MEASUREMENTS and MAIN RESULTS: Patients were divided according to case control criteria as those who underwent laparoscopic removal of myomas (106) and those who did not (106); both groups were compared with 106 women with unexplained infertility without myomas. Of the 318 women, 83 (26%) became pregnant and delivered live infants. The 44 (42%) who underwent surgical removal of leiomyomas had higher delivery rates than 12 (11%) who did not undergo surgery (p <0.001) and 27 (25%) who did not have myomas (p <0.001). Patients whose myomas were not surgically treated had fewer deliveries than women who did not have myomas (12 vs 27, p <0.002). Fifteen women had spontaneous abortions before week 12: 3 (3%) who had surgery, 10 (9%) who did not have surgery, and 2 (2%) who did not have myomas. CONCLUSION: Laparoscopic myomectomy improved pregnancy rates over nonsurgical management of myomas.