Role of reproductive surgery in the era of assisted reproductive technology

Reproductive surgery could be divided into surgery as a primary treatment for infertility, surgery to enhance in-vitro fertilisation outcome, and surgery for fertility preservation. A shift has occurred away from surgery as a primary treatment of infertility to surgery playing a crucial part in enhancing in-vitro fertilisation outcome and for fertility preservation. A normal uterine cavity is a prerequisite for implantation, and hysteroscopic correction of intrauterine pathology, including polypectomy, myomectomy and metroplasty, increases the chances of having a successful pregnancy. Management of hydrosalpinx before in-vitro fertilisation treatment by laparoscopic salpingectomy or proximal tubal occlusion increases the in-vitro fertilisation delivery rate. Finally, surgery plays an important role in preservation of fertility. This includes laparoscopic ovarian transposition, ovarian tissue removal for cryopreservation and ovarian transplantation. (C) 2012 Elsevier Ltd. All rights reserved.