O-124 What is the role of tubal surgery in the era of ART?

Abstract Role of Tubal surgery in the era of art Tubal surgery is not very popular these days due ti the amazing important and successes of ART. However: • access to IVF is far for granted in a many countries for financial, cultural or religious reasons • ivf is not always successful • tubal surgery is sometimes necessary before ivf in case of hydrosalpinx and conservative surgery may be discussed being in some cases a very valid option. • recently subtle tubal abnormalities has been studied and demonstrate their importance in infertility Therefore it seems important to redefine the place of tubal surgery, taking in account the fact that ivf doctors have usually no surgical skills, and that surgeons with tubal skills are not numerous nowadays. It is also important to recall the principles of tubal surgery: tubes are complex and fragile organs and deserved to be preserved. That is possible is the principles of microsurgery (today done by laparoscopy) are applied: magnification, selective hemostasis, irrigation, gentle handling of the tube with atraumatic instrumentation and microsutures when needed. A special attention must be observed when adhesions are present which is very often the case. Meticulous adhesiolysis and prevention of recurrence are essential. If careful selection of cases and appropriate technique are used then we may expect very good results in term of pregnancy, similar which was is obtain with ivf It seems very important to teach these principles of tubal surgery in medical school and to have at least one reproductive surgeon in every ART team.