Reproductive Surgery vs Assisted Reproductive Technologies: Selecting the Correct Alternative

Abstract

Many innovations have been made in advanced reproductive technologies (ART) over the past several years. These procedures now yield pregnancy rates of over 20% per cycle, rates that compare favorably to many types of reproductive surgery. Therefore, ART now represents a viable alternative for many patients suffering from infertility. As these pregnancy rates continue to rise, gynecologists will have to choose between ART and reproductive surgery for a larger number of patients. This article reviews the commonly performed reproductive surgical procedures and compares expected postoperative pregnancy rates to those of ART in order to help the gynecologist make this decision.

The role of tubal reconstructive surgery in the era of assisted reproductive technologies

“…Other causes of tubal injury are associated with more favorable results. After reversal of elective sterilization procedures, reported cumulative pregnancy rates have ranged from 40% to 80% (8). Cycle fecundability after sterilization reversal ranges between 8% and 10%, with an overall risk for ectopic pregnancy risk of less than 10%.…”

“…Microsurgical tubal anastomosis and IVF are both proven options. Microsurgical repair yields cumulative pregnancy rates ranging from 40% to 80% and monthly fecundability of 8% to 10% (4,8). The risk of ectopic pregnancy is generally less than 10%.…”

Comparison of outcomes and direct cost between minimal stimulation and conventional protocols on ovarian stimulation in in vitro fertilization

“…However, both protocols have a similar cancellation rate 1 . Some studies, 2,3 but not all, 4 have suggested that premature luteinization correlates with poor in vitro fertilization (IVF) pregnancy outcome. A decrease in the pregnancy rate may be either secondary to a favorable follicular milieu with poor oocyte and embryo quality, or an adverse effect on endometrial receptivity 5 …”