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Keywords:

  • assisted reproductive technology;
  • endometriosis;
  • fibroids;
  • hydrosalpinx;
  • in vitro fertilisation;
  • surgical interventions;
  • uterine anomalies

Key content

  • Assisted conception technology such as in vitro fertilisation (IVF) is the first-line treatment of many causes of female subfertility and surgery is offered primarily to optimise the outcome of such treatments.
  • An awareness and understanding of the evidence about the different surgical interventions used prior to assisted conception is essential in achieving the best possible outcome.

Learning objectives

  • To assess the fertility needs of women including the need for surgery.
  • To understand the role of different surgical interventions prior to assisted conception for the management of hydrosalpinx, uterine fibroids, uterine pathology such as a uterine septum and intrauterine adhesions, and the treatment of endometriosis and ovarian endometriomas.

Ethical issues

  • Women should be counselled about the benefits and risks of surgery including the risk of delay to their assisted conception.
  • A sympathetic approach is needed for women who are already emotionally and physically stressed.
  • There are financial implications involved in IVF treatment.
  • Psychosocial issues and anxiety require a multidisciplinary approach.