The diminished role of tubal surgery in infertile women following widespread access to IVF is now being reviewed as more patients and surgeons today consider tubal surgery as an effective alternative to assisted reproduction treatment in certain circumstances. The limitations of and lack of patient acceptance of assisted reproduction treatment for ethical and moral reasons have contributed to this change as well as advances in surgical techniques and instrument technology, notably developments in endoscopic surgery. Strategies in tubal surgery are largely unchanged but the mini-invasive nature of the endoscopic approach has added value because of less tissue trauma, better visualization of the operative field and more rapid healing, which make surgery using today's techniques an integral part of the treatment strategy in infertile couples.
tubal surgery alternative to IVF infertility treatment, laparoscopic tubal surgery adhesion management review, endoscopic tubal surgery techniques fertility restoration, tubal factor infertility surgical treatment vs assisted reproduction, mini-invasive tubal surgery adhesion prevention, ethical objections IVF tubal surgery alternative, restorative tubal surgery infertile women outcomes, Watrelot tubal surgery current practice review, fallopian tube microsurgery endoscopic approach, patient acceptance IVF moral reasons tubal surgery
PMID 21550854 21550854 DOI 10.1016/j.rbmo.2011.03.018 10.1016/j.rbmo.2011.03.018
Cite this article
watrelot, A., & Chauvin G (2011). Current practice in tubal surgery and adhesion management: a review. Reproductive biomedicine online, 23(1), 53-62. https://doi.org/10.1016/j.rbmo.2011.03.018
watrelot A, Chauvin G. Current practice in tubal surgery and adhesion management: a review. Reprod Biomed Online. 2011;23(1):53-62. doi:10.1016/j.rbmo.2011.03.018
watrelot, antoine, and Chauvin G. "Current practice in tubal surgery and adhesion management: a review." Reproductive biomedicine online, vol. 23, no. 1, 2011, pp. 53-62.
Salpingostomy for hydrosalpinx was carried out using a microsurgical technique. The postoperative patency rate was over 90%. Among the 41 patients followed for more than 1 year, 29% have had one or more intrauterine pregnancies and 27% have had live births. The ectopic gestation rate was 12%. All of the tubal gestations occurred in the 1st postoperative year whereas 60% of the intrauterine pregnancies occurred after the 1st year, suggesting a degree of restoration in the mucosa and the musculature of the oviduct with the re-establishment of patency and the passage of time.
Reimão Miller KA et al., 2026·Reproductive biomedicine online
This review explores whether the clomiphene citrate stair-step protocol (SSP) for ovulation induction in patients with polycystic ovary syndrome (PCOS) outperforms the traditional protocol. The following PubMed, Cochrane Library, ClinicalTrials.gov, EMBASE and Google Scholar from inception to 15 June 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with PROSPERO registration (CRD420251050294). Of 847 screened records, five randomized controlled trials were included (n = 520: n = 255; n = 265). Analyses were conducted in Review Manager 5.4 using random-effects models. Risk ratios, mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed with I², risk of bias with RoB2, certainty with GRADE and robustness with leave-one-out sensitivity analysis. The SSP increased ovulation rates compared with the traditional protocol (RR 1.28, 95% CI 1.10 to 1.49; five randomized controlled trials [RCTs], n = 520, I² = 0%). Clinical pregnancy also favoured SSP (RR 1.46, 95% CI 1.04 to 2.05; four RCTs, n = 460; I² = 0%), although this result was largely driven by one study. The SSP shortened treatment duration (mean difference -32.59 days, 95% CI -38.66 to -26.52 days; three RCTs, n = 320, I² = 83%). Endometrial thickness was similar (mean difference 0.32 mm, 95% CI -0.95 to 1.59 mm; four RCTs, n = 460, I² = 91%). SSP improves ovulation rate and shortens treatment without affecting endometrial thickness and may increase clinical pregnancy rates.
Zegers-Hochschild F et al., 2026·Reproductive Biomedicine Online
What are the trends and effects of assisted reproductive technology (ART) interventions on the effectiveness and safety of ART carried out in Latin America during 2022. Retrospective collection of cycle-based multinational data obtained from ART procedures carried out by 204 accredited institutions in 16 countries. In total 123,265 initiated cycles resulted in 19,663 deliveries and 22,203 births. Use of ART varied greatly, from 643.3 cycles/million inhabitants in Uruguay to 28.8 in Guatemala. In autologous cycles, the proportion of women aged ≥40 years represents 35.1% of cycles, whereas women <34 years represents only 18.8%. The proportion of single embryo transfers (SET) increased from 42.4% in 2021 to 47.3% in 2022. Out of 22,203 babies born, 77.4% were singletons, 21.7% twins and 0.9% triplets or more. Intracytoplasmic sperm injection represented 85.4% of fertilization techniques, and blastocyst transfer increased from 79.3% in 2021 to 85.3% in 2022. Delivery rate after fresh blastocyst elective single embryo transfer (32.6%) was significantly higher than after the transfer of one frozen embryo transfer (FET) from freeze-all cycle (25.2%) (P = 0.0001). The number of aspirations leading to preimplantation genetic testing increased 2.6 times in 6 years, and significantly increased delivery rates/transfer (P ≤ 0.008) and reduced miscarriage at all ages (P ≤ 0.004) in autologous cycles, but not in oocyte donation cycles. Delivery rates after fresh transfer of embryos from vitrified-warmed donated oocytes, generated similar outcome to FET from fresh oocyte donation cycles (P = 0.5621). Perinatal mortality increased from 7.5‰ in singletons to 22.8‰ in twins. Systematic collection of cycle-based multinational data contributes to cooperative sustained development and helps implement evidence-based reproductive decisions.
Farlie F et al., 2024·Reproductive biomedicine online
The healthcare industry is a major contributor to greenhouse gas emissions. Assisted reproductive technology is part of the larger healthcare sector, with its own heavy carbon footprint. The social, economic and environmental costs of this collective carbon footprint are becoming clearer, as is the impact on human reproductive health. Alpha Scientists in Reproductive Medicine and the International IVF Initiative collaborated to seek and formulate practical recommendations for sustainability in IVF laboratories. An international panel of experts, enthusiasts and professionals in reproductive medicine, environmental science, architecture, biorepository and law convened to discuss the topics of importance to sustainability. Recommendations were issued on how to build a culture of sustainability in the workplace, implement green design and building, use life cycle analysis to determine the environmental impact, manage cryostorage more sustainably, and understand and manage laboratory waste with prevention as a primary goal. The panel explored whether the industry supporting IVF is sustainable. An example is provided to illustrate the application of green principles to an IVF laboratory through a certification programme. The UK legislative landscape surrounding sustainability is also discussed and a few recommendations on 'Green Conferencing' are offered.