TUBAL SURGERY OR IVF - MAKING THE BEST CHOICE IN THE 1990S

Although there are tubal causes of infertility for which surgery offer s little or no chance of successful treatment, there are at least two situations-sterilization reversal and microsurgical or laparoscopic ad hesiolysis in the absence of fimbrial damage and/or male factor-in whi ch subsequent live birth rates are excellent, 60-80% for the former an d 45-65% for the latter. An advantage of tubal reconstruction over IVF -ET, which is the only viable alternative in tubal infertility, is avo idance of the risks of the stimulated ovulation protocol and multifeta l gestation. Of course, the demands of microsurgery or operative lapar oscopy are stringent; and the decision to undertake tubal reconstructi on instead of IVF-ET must be coupled with appropriate patient selectio n.