Surgical management of tubal disease and infertility

With the recent advances made in endoscopy techniques, many reproductive surgical procedures that traditionally required laparotomy can now be performed on a day surgery basis by endoscopy with improved results, safety, cost-effectiveness and quicker recovery times. Surgery remains an important option and complement to assisted reproductive technologies. Reproductive surgery should be considered as the first-line treatment when the correction of infertility pathologies is simple and a good result is expected once corrected, when the pathology is causing symptoms such as pain or abnormal bleeding or if uncorrected will compromise the results or increase the risks of ART. The success of surgical infertility treatment depends on the careful selection of cases using appropriate investigative techniques, with procedures performed in centres with sufficient expertise. For both specialized reproductive and general gynaecological surgery, it is paramount carefully to follow the microsurgical principles to avoid adhesion formation and conserve normal tissues especially tubal and ovarian. These various aspects of reproductive surgery are discussed in this article.