Is reproductive microsurgery dead, or has its demise been greatly exaggerated?
Victor Gomel (CA)
[Gomel] .
Is reproductive microsurgery dead ? Victor Gomel The success rate of ART has improved reaching a plateau of 26-30%. This led increasingly to the use of IVF as the primary treatment option in most cases; resulting in significant decline in use and teaching of reconstructive microsurgery. Despite improvements in IVF results, the cumulative probability of a live birth after three treatment cycles is around 54%. Further, studies demonstrated conclusively that a large proportion don’t complete three cycles, even when they are subsidized. ART is associated with a worrisome increase in multiple pregnancies and preterm births, with the associated consequences. In comparison reconstructive microsurgery is inexpensive offering multiple opportunities to attempt conception. Laparoscopic salpingostomy improves the outcome of subsequent IVF, offering potential for spontaneous conception. Microsurgical sterilization reversal, is preferable to IVF in younger women without other fertility factors; it offers higher cumulative birth and normal multiple rates . Surgery is the only alternative for women with tubal infertility, who for personal or other reasons refuse ART. Reconstructive surgery and ART are complementary enabling greater success for patients presenting with complex fertility problems. Training in reconstructive microsurgery should be an integral part of subspecialty training in REI. GomelV. RBMO. 2015;31:722-731. Fertil Steril. 2016;105:887-90; 106:998-1010; 106:991-993; 106:1025-1031;