Surgical treatment of female infertility.

Surgery plays a vital role in overcoming identifiable problems of infertility. Problems such as incompetent cervix can be repaired by cerclage procedures with a 70-80% chance of carrying a gestation to the stage of viability. The septateuterus a congenital uterine abnormality is the cause of most reproductive failure. However regardless of the technique used for excision of the uterine septum selected patients can achieve an 85% chance of a living child. For fibromyomata uteri a myomectomy offers a term delivery in 50% of the cases; although recurrence of fibrimyomata following myomectomy occurs in 20-30% of the cases. Uterine synechiae treated by transcervical release of adhesion and insertion of a uterine device to prevent recurrence results in a 40-50% successful pregnancy rate. Mid-segment reconstruction is used to resect the obstructed oviduct usually due to prior tubal ligation. Uterotubal implantation by cornual wedge excision or the reamer technique relieve corneal obstruction with a 30-40% pregnancy success. Ovarian surgery is limited to benign cyst resection wedge resection in sclerocystic ovarian syndrome and perhaps paridoxical oophorectomy. A therapeutic approach for endometriosis using estrogenic hormone preparations to eliminate ovulation progestogens to maintain a decidual state in the endometrium and androgens to relieve symptoms and promote pregnancy provide generally lower pregnancy rates than surgery alone which provides a 50-60% pregnancy rate.