Surgery in contemporary infertility

Laparoscopic surgery has developed quickly and is preferred over laparotomy for most surgery in female infertility. In vitro fertilization (IVF) has emerged as the main treatment for tubal infertility, but surgery still has a definite place. In particular, patients with hydrosalpinx should undergo a laparoscopy for evaluation of salpingectomy before IVF or reconstructive surgery for attempts of spontaneous conception. Mild-to-moderate adhesions are also suitable for surgery. Although it has been shown that fibroids influence implantation negatively, the value of myomectomy for small and intramural or subserosal fibroids has been insufficiently investigated. The surgical management of endometriosis is controversial. The ablation of endometriotic peritoneal implants might increase the spontaneous conception rate. Repeat surgery in severe disease should be avoided. The indications and results for these and other fertility-enhancing procedures are evaluated according to the most recent publications.