Key content The pathogenesis of infertility is multi‐factorial; investigative and treatment approaches should therefore be individualised. There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function. There is often a clear need for in vitro fertilisation (IVF) in the management of infertility. This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART). Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans‐vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency. To understand the role of Chlamydia trachomatis serology in tubal patency testing. To evaluate the role of tubal patency test in the hierarchy of investigations for infertility. To understand the role of tubal surgery in modern management of infertility. To understand the importance of medical history taking in infertility. Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception. Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF? There may be psychosocial issues or anxiety so a multidisciplinary approach is important.

Key content Assisted conception technology such as in vitro fertilisation (IVF) is the first‐line treatment of many causes of female subfertility and surgery is offered primarily to optimise the outcome of such treatments. An awareness and understanding of the evidence about the different surgical interventions used prior to assisted conception is essential in achieving the best possible outcome. Learning objectives To assess the fertility needs of women including the need for surgery. To understand the role of different surgical interventions prior to assisted conception for the management of hydrosalpinx, uterine fibroids, uterine pathology such as a uterine septum and intrauterine adhesions, and the treatment of endometriosis and ovarian endometriomas. Ethical issues Women should be counselled about the benefits and risks of surgery including the risk of delay to their assisted conception. A sympathetic approach is needed for women who are already emotionally and physically stressed. There are financial implications involved in IVF treatment. Psychosocial issues and anxiety require a multidisciplinary approach.

Pterygium excision by bare sclera technique was first described by Ombrain. However it is associated with recurrence rate of 9 to 75%. Conjunctival autografting is safe and cost effective method in preventing recurrence. In this study 100 cases of primary pterygium are evaluated. Mean age group was 47 years. 55% were male and 45% were females. Literature documents more incidence of pterygium in outdoor workers. This correlated with our study findings where in 66% of the patients were exposed to heat dust and sunlight while working outdoors. 89% had nasal pterygium. Most Patients (87%) had with the rule astigmatism. The average with the rule astigmatism was 2 diaptors preoperatively which decreased to 0. 67D postoperatively. In our study of 100 cases 50 underwent pterygium excision by bare sclera technique. Rest 50 underwent pterygium excision with conjunctival autografting. All cases were followed up for 6 months. In the bare sclera technique 6 (12%) cases had recurrence and none in conjunctival autograft technique (p-value < 0.05). Two cases had sclera thinning following pterygium excision which resolved after tapering steroid dosage. 2 cases had graft edema and three had loose sutures. 4 cases had granuloma formation in the bare sclera group and one had corneal scarring.

Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50 per cent of parous women, although many are asymptomatic. Treatments include surgery, mechanical devices and conservative therapies. The authors describe a variety of mechanical devices or pessaries that aim to alleviate the symptoms of prolapse and avert or delay the need for surgery. Copyright © 2009 Wiley Interface Ltd