Editorial: Minimally invasive surgery as a mean of improving fertility: What do we know so far?

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This editorial reviews recent trends in reproductive surgery, highlighting the efficacy of salpingectomies for IVF outcomes, the use of testicular sperm for ICSI, and surgical management of uterine fibroids and endometriosis to improve fertility.

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This editorial summarizes evidence and trends on reproductive surgery aimed at improving fertility, including studies on timing and sequencing of salpingectomy relative to oocyte retrieval for IVF, and the use of testicular versus ejaculated sperm for ICSI after failed embryo transfer. It also reviews minimally invasive approaches for uterine fibroids (weighing myomectomy risks such as adhesiogenesis) and for endometriosis, noting that excision of deep lesions and CO2 laser vaporization of ovarian endometriomas may improve ART outcomes while natural conception effects remain unclear. The authors explicitly frame the overall evidence as indecisive because it is mainly based on retrospective studies and emphasizes the need to clarify timing and endometriosis subtype/classification in future research. This paper is centrally about endometriosis—an editorial that discusses how minimally invasive surgical management (e.g., excision of deep lesions and CO2 laser vaporization of endometriomas) relates to fertility and IVF outcomes.

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References

1. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. (2020) 113(3):533–5. 10.1016/j.fertnstert.2019.11.025 2. CoxCMThomaMETchangalovaNMburuGBornsteinMJJohnsonCLet alInfertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis. Hum Reprod Open. (2022) 2022(4):hoac051. 10.1093/hropen/hoac051 3. Recent advances in medically assisted conception. Report of a WHO Scientific Group. World Health Organization technical report series. (1992) 820:1–111. 4. DadhwalVChoudharyVPerumalVBhattacharyaD. Depression, anxiety, quality of life and coping in women with infertility: a cross-sectional study from India. Int J Gynaecol Obstet. (2022) 158(3):671–8. 10.1002/ijgo.14084 5. Makara-StudzińskaMLimaninAAnusiewiczAJanczykPRaczkiewiczDWdowiak-FilipAet alAssessment of quality of life in men treated for infertility in Poland. Int J Environ Res Public Health. (2022) 19(5). 10.3390/ijerph19052950 6. MeloPGeorgiouEXJohnsonNvan VoorstSFStrandellAMolBWJet alSurgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. (2020) 10. 10.1002/14651858.CD002125.pub4 7. LaganàASAlonso PachecoLTinelliAHaimovichSCarugnoJGhezziFet alManagement of asymptomatic submucous myomas in women of reproductive age: a consensus statement from the global congress on hysteroscopy scientific committee. J Minim Invasive Gynecol. (2019) 26(3):381–3. 10.1016/j.jmig.2018.06.020 8. FauconnierADubuissonJ-BAncelP-YChapronC. Prognostic factors of reproductive outcome after myomectomy in infertile patients. Hum Reprod. (2000) 15(8):1751–7. 10.1093/humrep/15.8.1751 9. Carranza-MamaneBHavelockJHemmingsR. The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can. (2015) 37(3):277–85. 10.1016/S1701-2163(15)30318-2 10. DonnezJDolmansMM. Hormone therapy for intramural myoma-related infertility from ulipristal acetate to GnRH antagonist: a review. Reprod Biomed Online. (2020) 41(3):431–42. 10.1016/j.rbmo.2020.05.017 11. LaganàASGarzonSDababouSUccellaSMedvedievMPokrovenkoDet alPrevalence of intrauterine adhesions after myomectomy: a prospective multicenter observational study. Gynecol Obstet Investig. (2022) 87(1):62–9. 10.1159/000522583 12. DiamondMP. Reduction of adhesions after uterine myomectomy by seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm adhesion study group. Fertil Steril. (1996) 66(6):904–10. 10.1016/S0015-0282(16)58716-0 13. MacerMLTaylorHS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. (2012) 39(4):535–49. 10.1016/j.ogc.2012.10.002 14. CasalsGCarreraMDomínguezJAAbrãoMSCarmonaF. Impact of surgery for deep infiltrative endometriosis before in vitro fertilization: a systematic review and meta-analysis. J Minim Invasive Gynecol. (2021) 28(7):1303–12.e5. 10.1016/j.jmig.2021.02.007 15. HartRJHickeyMMaourisPBuckettW. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. (2008) (2):CD004992. 10.1002/14651858.CD004992.pub3 16. CandianiMOttolinaJPosadzkaEFerrariSCastellanoLMTandoiIet alAssessment of ovarian reserve after cystectomy versus “one-step’ laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial. Hum Reprod. (2018) 33(12):2205–11. 10.1093/humrep/dey305 17. Ban FrangežHVrtacnik BokalEŠtimpfelMDivjak BudihnaTGulinoFAGarzonSet alReproductive outcomes after laparoscopic surgery in infertile women affected by ovarian endometriomas, with or without in vitro fertilisation: results from the SAFE (surgery and ART for endometriomas) trial. J Obstet Gynaecol. (2022) 42(5):1293–300. 10.1080/01443615.2021.1959536 18. ŠalamunVVerdenikILaganàASVrtačnik-BokalE. Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis. Arch Gynecol Obstet. (2018) 297(3):613–21. 10.1007/s00404-017-4633-0 Summary

Keywords

endometriosis, fibroids and fertility, minimally invasive surgery, infertility, in-vitro fertilisation (IVF) Citation Naem A and Laganà AS (2023) Editorial: Minimally invasive surgery as a mean of improving fertility: What do we know so far?. Front. Surg. 10:1203816. doi: 10.3389/fsurg.2023.1203816 Received 11 April 2023 Accepted 03 May 2023 Published 15 May 2023 Volume 10 - 2023 Edited and reviewed by Stefano Cianci, University of Messina, Italy Updates Copyright © 2023 Naem and Laganà. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: Antoine Naem [email protected] Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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