How microsurgery can assist in tubal reconstruction.

Despite the fact that gynecologists were very early users of the operating microscope to observe the possible pathology of the cervical mucosa by brilliant lighting and magnification, the advent of in vitro fertilization (IVF) seems to have stopped this specialty from using the benefits of microsurgery in female tubal reconstruction. Now having performed and followed up for at least 2 years nearly 1000 microsurgical tubal reconstructions after sterilizations, with an endpoint being the birth of a baby in the time following, it is obvious that there are real benefits in pursuing these techniques, because no single IVF Unit in the world gets even half as many live birth results from their best practices. Apart from a genuine 82.7% baby result from all comers, of any child-bearing age and "sterilization age," with an ectopic pregnancy rate of <1%, there are the benefits of (i) a single procedure, (ii) normal intercourse to become pregnant is the way to go, (iii) psychological trauma of the women involved is not a problem, and (iv) the next baby after the first is "free." In our opinion, it is sensible to scientifically attempt to reconstruct a deliberately blocked tube in the first instance because it is healthier (for mother and children), less expensive, more satisfying and psychologically acceptable, and is certainly far more reliable in its results than any other baby-promoting proceedure now available. It is regretted that gynecologists who flocked to workshops teaching microsurgical gynecological techniques before IVF was established now do not even seem to consider giving the operative reconstruction as a first alternative to their couples that come to them with sterilization as the cause of infertility.