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Tubal surgery in the era of IVF


Today, over 30 years after that first IVF birth, IVF has nearly replaced all other forms of fertility management. The rapid industrialisation of IVF treatment has inappropriately imprinted in may people that IVF (in-vitro fertilisation) is the easiest way to overcome most fertility problems. Certainly while IVF is a successful approach to pregnancy, it is not plausible to believe that "one size fits all".

Tubal surgery should be attempted, at least in some selected cases, to restore normal tubal function before recommending IVF.

Nowadays when dealing with hydrosalpinges (fluid in the tube), salpingectomy (removal of the tube) is routinely performed prior to IVF, thus offering women no more hope to achieve a pregnancy spontaneously. The issue raised by some reproductive surgeons like Mr Nardo is "why not salpingostomy (opening the tube and draining the fluid)?", which is more conservative and may leave the woman with a chance to conceive without undergoing IVF in the future.

Another example where tubal surgery could be as effective as, if not more than, IVF is reversal of sterilisation in couples in whom tubal ligation is the only limiting step to conception. The reported pregnancy rates after mini-laparotomy or laparoscopy (keyhole) are as high as 80% in good prognosis women. Patient selection and surgical skills are crucial to the success of the surgery.

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