Laparoscopy in cases of infertility, tubal pathology, endometriosis and before ART

Even if laparoscopy is awarded the status of a gold standard in the diagnosis of involuntary childlessness, assisted reproductive techniques (ART) have initiated a paradigm shift and many steps in the fertilization process are technically assisted. The question arises as to what evidence exists for the use of laparoscopy for the various causes of sterility. It is laparoscopy that keeps the proportion of so-called unexplained sterility low and that can be immediately expanded to include a surgical intervention. In the case of tubal pathology, laparoscopic salpingo-ovariolysis with preserved tubal patency leads to results that are superior to ART. Among the Federation internationale de gynecologie et d & apos;obstetrique (FIGO) myoma types 0, 1, 2, 2-5, 3, 4, 5, 6, the myomas adjacent to the cavity of the uterus develop the highest fertility-blocking effects, which must also be assumed for the myoma types 3, 4, 5, 6, although the cavity is not distorted. Myoma types 0, 1, 2 are a domain of hysteroscopic surgical techniques, all others myomas can successfully be operated on laparoscopically as long as there is a sufficiently high plane between the optical trocar and the object for the insertion of the working trocars. For the various phenotypes of endometriosis, priority is given to laparoscopic intervention in cases of treatment-resistant pain. In particular, stenosing processes in the urinary tract and the intestines are indications for laparoscopy. In cases of hydrosalpinx, a benefit is ensured by laparoscopic salpingectomy before in vitro fertilization (IVF). There are subgroups of endometriosis that benefit from the principle of surgery first before ART.