Competing Endoscopic Surgeries in the Era of Assisted Reproductive Technologies: Evidence and Practice
Now-a-days the assisted reproductive technologies (ART) are progressing and advancing rapidly. Many reproductive medicine specialists do believe in ART to be the first choice for infertile women regardless of age related issues while gynecologists do believe in reproductive surgery as basic treatment option for these patients. Debate is still unsolved between reproductive
surgery or ART which is the first choice for management of infertility. Many issues increase
the complexity of the debate as age of infertile patient, ovarian reserve and previous management whether surgery or ART. In this review, both aspects were discussed to clear some aspects
of this debate. The objective of this review is to highlight this debate and mention the aspects
which help gynecologists and reproductive surgeons to choose the best for infertile patients.
Tubal surgery is the first-line management option for young women less than 35-years-old with
minor tubal pathology. The second option should be IVF if there are other factors affecting
fertility, if the patient is >38-years-old, if patient had moderate to severe tubal disease, and if
one year or more had passed post-surgery for tubal pathology.
Hydrosalpix is a common tubal pathology that affects IVF/ICSI results by many mechanisms.
Surgical treatment should be considered for all women with hydrosalpinges prior to IVF/ICSI
procedures. Previous evidence supported only unilateral salpingectomy for a unilateral hydro salpinx (bilateral salpingectomy for bilateral hydrosalpinges).
Now evidence supports laparoscopic tubal occlusion as an alternative to laparoscopic salpingectomy in improving IVF pregnancy rates in women with hydrosalpinges.
Gynecol Obstet Res Open J. 2017; 4(2): 20-29. doi: 10.17140/GOROJ-4-140