The inadequate fatigue performance of Laser Powder Bed Fusion (L-PBF) Ti-6Al-4V alloy, primarily due to intrinsic defects, poses a significant challenge for industrial applications. Internal defects often serve as initiation sites for fatigue cracks, significantly impacting the fatigue life of L-PBF Ti-6Al-4V components. Accurate evaluation of the role of internal defects in fatigue performance and quantitative analysis of influential parameters are crucial for guiding optimal L-PBF manufacturing design. This study aims to critically review recent notable contributions focusing on high-cycle fatigue (HCF) in these alloys, with many of the presented insights being easily transferred to other types of AM alloys. Efforts have been made to identify correlations between fatigue life at various stages and critical internal defects. Key aspects, including microstructure and post-processing treatments, and their effects on HCF have been thoroughly analyzed. The findings enhance the scientific understanding of fatigue performance of L-PBF Ti-6Al-4V alloy and open new avenues for future research.