Tubal disease and fertility outcome.

A consequence of assisted reproduction technology in infertility management has been a decline in tubal surgery. Microsurgery to correct localized damage has the advantage of long-standing restoration of fertility. A simple prognostic classification is lacking. The severity of the tubal damage and the health of the mucosa is key in determining outcome. Visualization of the tube by hysterosalpingography (HSG) or by hysterocontrastsonography (HyCoSy) has limitations. Laparoscopy has the advantage of inspecting the tube and its relation to other pelvic organs. Differentiating between anatomical obstruction or spasm at the uterine end of the tube might be achieved by selective salpingography and tubal catheterization (SSTC) and should precede IVF. Microsurgery should be provided, if the skills are available, where cannulation has failed. Assessment of mucosal health by fertiloscopy is claimed to be less invasive. Fertiloscopy includes hydrolaparoscopy, tubal patency testing by dye hydrotubation, salpingoscopy and demonstration if the mucosa is healthy. Where the mucosa is unhealthy, surgery is not justified; early referral for IVF is indicated. In the management of ectopic pregnancy, there is a paucity of objective data of the relative merits of medical regimens and various surgical procedures.