Surgical management of tubal disease and infertility

With the advance in assisted reproductive technology (ART), the role of reproductive surgery as the primary treatment of infertility has been questioned. Tubo-peritoneal factor is common, and accounts for 30–40% of female infertility. The pathology of tubal disease ranges from peritubal adhesion, proximal and/or distal tubal blockage, hydrosalpinx to previous sterilization. In tubo-peritoneal infertility, reproductive surgery remains an important option and is complementary to ART. It should be considered as the first-line treatment if a good result is expected when the pathology is amendable or if untreated will adversely affect the results or increase the risks of ART. The success of reproductive surgery depends on careful patient selection using proper investigative tools, performed in units with expertise following microsurgical principles.