Surgical management of tubal disease and infertility

With the advances in assisted reproductive technology (ART), the role of reproductive surgery as the primary treatment of infertility has been questioned. Tubo-peritoneal factor infertility is common, and accounts for 30-40% of female infertility. The pathology of tubal disease ranges from peritubal adhesions, proximal and/or distal tubal blockage, hydrosalpinx to previous sterilisation. In tubo-peritoneal factor 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 left untreated will adversely affect the results of ART. The success of reproductive surgery depends on careful patient selection using proper investigative tools, performed in units with expertise following microsurgical principles.