The study investigated whether routinely obtained preoperative data (age, FIGO classification, initial fibroid volume, and Doppler score) predict a ≥50% reduction in uterine fibroid volume after transvaginal radiofrequency ablation (RFA). This was a retrospective case series in a single center in Romania in 28–42 women (mean age 38 years) with symptomatic fibroids. Fibroid volume decreased from a mean of 60.82 cm³ to 28.3 cm³, a decrease of 54.0%, and the Doppler score decreased from 3.419 to 0.89. In logistic regression analysis, there were no statistically significant associations with patient age or FIGO classification. A proof-of-concept analysis applied machine learning to four preprocedural variables, but highlighted the challenges of a small sample. Successful results in two submucosal fibroids (G0 and G1) demonstrate the potential of RFA before hysteroscopic myomectomy to preserve fertility. The authors emphasize the need for larger prospective multicenter studies due to small sample size and class imbalance.