Uterine leiomyomas (fibroids) are common benign tumours affecting women of reproductive age. While most are asymptomatic, a significant proportion experience symptoms affecting their quality of life. Surgery is a definitive treatment for fibroids, where minimally invasive surgical (MIS) techniques have become the preferred approach for preserving fertility. This narrative review provides an overview of the current literature regarding fertility outcomes of different MIS techniques, including conventional laparoscopy, robot-assisted laparoscopy myomectomy (RALM), and mini-laparotomy. The studies reviewed reveal favourable pregnancy outcomes in general which were comparable between laparoscopy, and RALM, single-site and mini-laparotomy. In RALM, higher preterm rates were associated with a higher number of fibroids being removed. The data was inconsistent regarding laparotomy compared to laparoscopy. Further comparative research may be warranted to determine the specific differences regarding fertility outcomes.