Key content
Assistedconceptiontechnology suchas in vitrofertilisation(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.
Keywords: assisted reproductive technology / endometriosis /fibroids / hydrosalpinx / in vitro fertilisation / surgical /interventions / uterine anomalies
Introduction
Salpingectomy for management of hydrosalpinx
Myomectomy for management of uterine fibroids
Hysteroscopy and hysteroscopic surgeryfor the management of uterine cavity abnormalities
Intrauterine adhesions
Uterine septum and other uterine anomalies
Surgery for endometriosis
Superficial endometriosis
Endometriomas
Conclusion
The influence of fibroids, endometriosis and uterine
anomalies on fertility is poorly understood and this limits a
proper understanding of the role of various surgical
interventions in the context of subfertility management.
Most of the available evidence is retrospective and while
prospective data using appropriately matched controls are
emerging, the heterogeneity of reproductive diseases and
their treatments presents a significant challenge to conduct
large well-designed randomised trials.
An individualised treatment plan should be implemented
taking into account the patient’s age, duration of subfertility,
previous treatments, local surgical expertise and other
causative factors.