Role of surgery to optimise outcome of assisted conception treatments

Abstract

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.

An overview of assisted reproductive technology procedures

“…Pelvic pathologies, such as hydrosalpinx, endometriosis, benign leiomyomas, uterine anomalies and intrauterine adhesions, may have a negative impact on fertility and ART success. Suresh and Narvekar reviewed the available evidence and made good practice recommendations about the role of pre‐ART surgical interventions for these reproductive diseases (Table ).…”

The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques

“…Therefore, the need to perform tubal patency test to rule out a hydrosalpinx that is not obvious on routine ultrasound examination is debatable and should be reserved for women with recurrent implantation failures despite the transfer of high‐quality embryos. Indeed there is strong evidence, albeit without any biological plausibility, of the therapeutic benefit of cavity check by hysteroscopy in women with at least two IVF implantation failures . Therefore the ideal test in women with such a background is HyCoSy which combines cavity check with tubal assessment.…”