Tubal surgery of IVF--making the best choice in the 1990s.

Although there are tubal causes of infertility for which surgery offers little or no chance of successful treatment, there are at least two situations-sterilization reversal and microsurgical or laparoscopic adhesiolysis in the absence of fimbrial damage and/or male factor-in which subsequent live birth rates are excellent, 60-80% for the former and 45-65% for the latter. An advantage of tubal reconstruction over IVF-ET, which is the only viable alternative in tubal infertility, is avoidance of the risks of the stimulated ovulation protocol and multifetal gestation. Of course, the demands of microsurgery or operative laparoscopy are stringent; and the decision to undertake tubal reconstruction instead of IVF-ET must be coupled with appropriate patient selection.