Reproductive surgery in the 21st century

The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR). The monthly fecundity rate, decreasing over time, and the time needed to reach the ultimate CPR are key factors in decision making. Depending on the clinical assessment, infertility treatment will be either with in vitro fertilization (IVF)/assisted reproduction technologies (ART) or with a diagnostic laparoscopy associated with reproductive surgery, which thereafter my require require IVF/ART. The comparison of IVF/ART treatment versus reproductive surgery is therefore the wrong debate as the CPR’s of reproductive surgery and of IVF are additive. Decisions should be based on the ultimate CPR’s and on effort and time, not on personal preferences. The large majority of women with infertility should have a diagnostic laparoscopy during which reproductive surgery can be performed if needed. IVF/ART treatment without a diagnosis decreases the ultimate CPR and is not without potentially serious adverse effects. Having excellent reproductive surgery readily available to patients, similar to the availability of IVF would increase CPR in women with infertility and decrease the overall cost.