Guideline No. 435: Minimally Invasive Surgery in Fertility Therapy

Abstract

Objective: To evaluate the benefits and risks of minimally invasive procedures in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients.

Target population: Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment.

Benefits, harms, and costs: Minimally invasive reproductive surgery can be used to treat infertility, improve fertility treatment outcomes, or preserve fertility. All surgery has risks and associated complications. Reproductive surgery may not improve fertility outcomes and may, in some instances, damage ovarian reserve. All procedures have costs, which are borne either by the patient or their health insurance provider.

Evidence: We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix A for MeSH search terms).

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix B (Tables B1 for definitions and B2 for interpretations of strong and conditional [weak] recommendations).

Intended audience: Gynaecologists who manage common conditions in patients with infertility.

Summary statements: RECOMMENDATIONS.

Keywords: endometriosis; fallopian tube; infertility; leiomyoma; minimally invasive surgical procedures; ovarian cysts.