Adenomyosis is frequent during the evaluation of infertile women. Present evidence suggests that adenomyosis has a negative impact on female fertility. Limited data from uncontrolled studies suggest that treatment of adenomyosis may improve fertility. This review critically appraises the existing evidence to determine the relationship between adenomyosis and female fertility. There is need for large epidemiological studies to substantiate the association between adenomyosis and infertility. Furthermore, if adenomyosis has a harmful impact on fertility there is a need to determine if its treatment improves fertility and the various treatment modalities reported need to be assessed for their effectiveness in randomised trials.