Uterine fibroids are the most common benign pelvic tumors in women of reproductive age. The intricate relationship between fibroids and fertility, along with their potential effects on pregnancy outcomes, represents a significant intersection in reproductive medicine and obstetrics. For patients desiring future fertility, myomectomy not only alleviates symptoms but also serves as a key intervention to optimize the chances of successful pregnancy. However, while preconception myomectomy removes the lesions, it simultaneously alters uterine anatomy and compromises myometrial integrity, thereby influencing subsequent pregnancy, delivery, and perinatal outcomes. This article reviews pregnancy outcomes following myomectomy, discussing the choice between laparoscopic and open surgical approaches, the optimal interval to conception after surgery, prenatal surveillance, mode of delivery, and the prevention and management of potential complications. The goal is to establish a comprehensive clinical management framework spanning from preoperative evaluation to postpartum follow-up.