As the acceptance of uterine artery embolization as a treatment option for uterine fibroids grows among patients and physicians, it appears that new questions are being asked about the patient selection criteria used for this procedure. In particular, patients with infertility issues or concerns about preserving fertility after fibroid treatment are often being evaluated for uterine artery embolization. This article was prepared to summarize the available literature regarding fertility preservation after both myomectomy and uterine artery embolization and to provide the reader with an algorithm for evaluating these patients and making literature-based treatment decisions.