Résumé
The goal for any infertile couple is to explore all reasonable attempts to achieve pregnancy. The couple with infertility resulting from tubal disease has two therapeutic options to achieve this goal: reconstructive tubal surgery and in vitro fertilization. However, the increasing demand for new techniques of assisted reproduction has called into question the value of the more established methods of treatment for tubal infertility. There are some causes of tubal infertility for which surgery has virtually no chance of success. For these situations, in vitro fertilization is clearly the only therapeutic option. For other situations, the decision-making process requires detailed discussion on the effectiveness, adverse effects and cost of the procedures. Endoscopic evaluation of the tubal mucosa is essential for the selective application of tubal surgery. The available evidence shows that tubal surgery can be as, or more, effective as in vitro fertilization for cases of filmy adhesions, mild distal tubal occlusion and proximal obstruction. It may, however, be reasonable to discuss in vitro fertilization with any couple without pregnancy 12 months after tubal surgery. In women with moderate to severe distal tubal disease, the diminishing success rates from surgery suggest that in vitro fertilization should be considered as the first line of treatment. In the case of unsuccessful reconstructive surgery, or if a hydrosalpinx is irreparably damaged, a salpingectomy prior to in vitro fertilization has to be considered. Tubal surgery has indisputable benefits for the patient if infertility is cured by the intervention. A successful tubal repair gives the patient the possibility of conceiving more than once without further treatment. It also gives the couple the psychological advantage of being able to conceive spontaneously. Probably the most pragmatic viewpoint is to consider reproductive surgery and in vitro fertilization as complementary options that are directed towards increasing the overall probability of achieving a pregnancy in the most efficient manner.