[Are there still indications for tubal surgery in infertility?].

In vitro fertilization (IVF) has revolutionalized management strategies proposed for infertility to the point where some have suggested that tubal surgery is no longer indicated. The objective being to obtain the largest number of viable births at minimum cost and maximum patient comfort, we strongly believe that tubal surgery and IVF are complementary tools for patients with tubal infertility. The choice depends on the severity and the localization of the lesions. For example, in patients with hydrosalpinx (the most frequent tubal lesion) and healthy or moderately altered mucosa, the rate of in utero pregnancies after tubal plasty by laparoscopic salpingostomy (53% in our series) is quite comparable with the rate after IVF. In this large group, tubal surgery should be proposed first. Tubal surgery may also be indicated in other less frequent lesions such as proximal obstructions where we have obtained excellent results (56% live births within 2 years of surgery). Of course, the final decision is made by the couple, well informed of the advantages and disadvantages of each technique. Performed by a well-trained team with extensive experience in reproduction, tubal surgery, particularly with the development of micro-instruments for laparoscopy, remains a treatment of choice for patients with tubal infertility.