Previous studies have shown that a thermomechanical treatment (TMT) consisting of cyclic plastic deformation in the temperature range of dynamic strain aging can increase the fatigue limit of quenched and tempered steels by strengthening the microstructure around non-metallic inclusions. This study considers the influence of a TMT on the shape, size and position of crack-initiating inclusions as well as on the internal crack propagation behavior. For this, high cycle fatigue tests on specimens with and without TMT were performed at room temperature at a constant stress amplitude. The TMT increased the average lifetime by about 40%, while there was no effect of the TMT on the form or size of critical inclusions. Surprisingly, no correlation between inclusion size and lifetime could be found for both specimen types. There is also no correlation between inclusion depth and lifetime, which means that the crack propagation stage covers only a small portion of the overall lifetime. The average depth of critical inclusions is considerably higher for TMT specimens indicating that the strengthening effect of the TMT is more pronounced for near-surface inclusions. Fisheye fracture surfaces around the critical inclusions could be found on all tested specimens. With increasing fisheye size, a transition from a smooth to a rather rough and wavy fracture surface could be observed for both specimen types.