Is laparoscopy necessary before assisted reproductive technology?

Abstract

PURPOSE OF REVIEW: Laparoscopy is widely used during infertility work-up, although it is sometimes unnecessary. This review highlights when laparoscopic intervention should be used in women undergoing assisted reproductive technology cycles. RECENT FINDINGS: There is no evidence for an increase in pregnancy rates in assisted reproductive technology cycles following surgical treatment of pelvic adhesions or endometriosis with laparoscopy. If the patient has bilateral visible hydrosalpinges, laparoscopy may be an option for evaluation of the tubes and treatment with salpingectomy in order to enhance the chance of pregnancy before commencing an assisted reproductive technology cycle. Laparoscopic ovarian drilling before assisted reproductive technology may be considered a therapeutic option in polycystic ovary disease patients who previously had severe ovarian hyperstimulation syndrome. Finally, laparoscopy may be useful in replacing the transposed ovaries to their original sites in the pelvic cavity in previously treated cancer patients so that monitoring of the controlled ovarian hyperstimulation and the oocyte aspiration would be much easier during the assisted reproductive technology cycles. SUMMARY: Laparoscopy should be considered before assisted reproductive technology cycles if the procedure diagnoses and treats a pelvic pathology at the same time and if laparoscopic intervention increases the chance of pregnancy following these cycles.