Abstract
Surgery is a main management strategy in treatment of infertility originating from uterine, ovarian or tubal pathologies. However, benefits of surgery in accordance with the type of pathologies could not always be predicted. In summary, this review revealed that surgical correction of some pathologies lead to a significant improvement in fertility, such as submucous myomas or intramural myomas distorting endometrial cavity; however, benefit of surgery is controversial in some specific conditions including endometriomas. Outcome of surgical correction mostly depends on the type of pathology in uterine anomalies. Surgical treatment is a well-established approach in management of hydrosalpinx and it should be recommended before assisted reproduction. Reproductive surgery should be individualized according to the patient characteristics including age, duration of infertility, previous pregnancy losses and type of associated pathology.
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Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
• Excision of endometrial polyps could improve fertility outcomes in infertile patients.
• Resection of submucous myomas results in a favorable fertility outcome. Despite, intramural myomas may have possible negative effects on fertility; subserous myomas are found irrelevant with infertility. Before planning surgery for intramural myomas, the size and number of myomas, as well as whether there is distortion of the uterine cavity should be taken into account.
• Surgery could be beneficial for some congenital uterine anomalies, particularly for uterine septum.
• Uterine transplantation is an experimental novel technique in patients without a uterus. Meticulous care must be applied to preserve ovarian reserve in endometriosis surgery. Ovarian drilling is cost-effective method in selected infertile PCOS patients resistant to conventional treatment. Surgery (salpingectomy or tubal occlusion with clips) should be recommended for patients with hydrosalpinx and infertility.