What is reproductive surgery? Reproductive surgery is a minimally invasive surgical technique that is an important part of infertility treatment and aims to preserve fertility or promote assisted reproductive techniques. In other words, it is a means of getting an infertility patient pregnant as soon as possible, either naturally or through artificial insemination/in vitro fertilization techniques. What can be done in reproductive surgery? Hysteroscopy, laparoscopy, tubaloscopy and tubal reinsertion, the so-called “three mirrors and one silk”. As we know, pregnancy involves many parts of the human body. The causes of infertility include female factors, male factors or unknown causes. Reproductive surgery is a comprehensive examination and treatment of the reproductive organs and pelvic environment of infertility patients to find out the cause and remove the unfavorable factors that affect pregnancy as much as possible, so as to achieve “examination and treatment at the same time”. After the surgery, the patient is guided to have intercourse with ultrasound monitoring of ovulation, artificial insemination or in vitro fertilization (IVF) to promote fertility. Is fertility surgery still needed in the IVF era? ”If you can’t get pregnant, you should do IVF, why do you need surgery?” ”Don’t all of your fertility centers do IVF?” All of you, this is not good enough. I do not know …. (1) Reproductive surgery can promote natural pregnancy: * For tubal adhesions, hydrocele, blockage and other so-called “tubal factors”, depending on the extent of the patient’s tubal mucosa and wall lesions, combined hysterolaparoscopic surgery can achieve an overall natural pregnancy rate of about 25%. * For infertility caused by endometriosis (endometriosis), laparoscopic surgery is currently the “gold standard” for examination and treatment. The higher the EFI, the higher the natural pregnancy rate; EFI score 9-10, the cumulative pregnancy rate 3 years after surgery is 70-80%; 6 is 50%; 4-5 is 20-40%; *For patients with endometriosis caused by abnormalities of the reproductive tract For infertility or recurrent miscarriage caused by genital tract abnormalities, corrective reproductive surgery can significantly improve fertility outcomes. For example, in the most common genital tract abnormality, “longitudinal uterus”, the pregnancy rate increases from 20.4% to 38.6% and the live birth rate increases from 18.9% to 34.1% after mediastinoplasty, with definite results. As you can see, these are all cases that promote spontaneous pregnancy. If we assess that the patient has a low rate of natural pregnancy after surgery, we will explain the condition to the patient and her family and recommend IVF as soon as possible to save time and money for the patient and to reduce the “detour”. Some people say, “If I knew that, I would have done IVF directly.” Gentlemen, this is not true again. Because hysteroscopic surgery is, first of all, a standard test for infertility to find the cause and treat it; secondly, it is not a waste of money to do reproductive surgery because it can improve the success rate of IVF. Why? Let me briefly introduce it. (2) After reproductive surgery, the success rate of assisted reproductive technology can be improved. *After laparoscopic treatment, the success rate of IVF increases and the incidence of ectopic pregnancy decreases. *If intraoperative mucosal destruction of the fallopian tubes is found to be severe, or “thick-walled hydrocele”, the natural pregnancy rate after surgery is extremely low, and then we will explain the condition to the patient’s family and recommend tubal ligation and then IVF as soon as possible. Because firstly, hydrocele has adverse effects such as mechanical flushing, embryotoxicity, reduced endometrial tolerance and inhibition of sperm viability, which can increase the spontaneous abortion rate by more than 2 times and decrease the IVF pregnancy rate by 50%. The recurrence rate after tubal ostomy is high, statistically up to 70% or more. Therefore, it is recommended to perform ligation in patients with severe tubal lesions to cut off the flow of fluid into the uterine cavity and improve the success rate of IVF. Our center has a large number of patients with successful IVF after tubal ligation, so if you are interested, you can share them in our patient group. Tubal ligation can also reduce the incidence of ectopic pregnancy after IVF. According to statistics, the incidence of ectopic pregnancy after natural pregnancy is about 1-2%, but after IVF the incidence of ectopic pregnancy can rise to 2.1%-8.6%, and up to 11% if the patient has tubal infertility factors. In our fertility ward, tubal ligation is performed to prepare the patient for IVF, and the site is the proximal part of the interstitial tubes bilaterally, which is different from the general family planning “ligation”. This can reduce the incidence of ectopic pregnancy after IVF by 87.5-92.5%, allowing patients to suffer less from “second chance”. *The success rate of embryo implantation can be significantly improved by cautery destruction of the pelvic endometriosis lesion and pelvic irrigation during the procedure.