Surgical correction of sequelae of pelvic inflammatory disease.

Early diagnosis of pelvic inflammatory disease (PID) and treatment with appropriate doses and types of antibiotics that take into account the polymicrobial etiology of this condition are essential to prevent future infertility. That PID frequently is subacute or relatively asymptomatic argues in favor of a more liberal use of laparoscopy in the diagnosis of this condition. The sequelae of PID that cause infertility can be assessed with the judicious use of hysterosalpingography and laparoscopy. These procedures are complementary. Hysteroscopy is of more limited value. Operative laparoscopy has proven to be useful in restoring fertility in appropriately selected cases. In many instances laparotomy can be replaced successfully with laparoscopic procedures, which offer many advantages. The introduction of microsurgery has significantly improved the success rate associated with reconstructive infertility operations. The successes associated with a new therapeutic modality, in vitro fertilization (IVF) and embryo transfer (ET), although modest, have been improving in the past three years. Reconstructive microsurgery and IVF/ET are complementary treatments for infertility. A thorough investigation of the infertile couple, with meticulous attention given to the various fertility parameters, individualization and a rational approach to treatment with these two modalities will undoubtedly improve the overall results.