Studies on the effectiveness of endoscopic surgery in reproductive medicine

This doctoral thesis appraises evidence-based practice in the field of reproductive surgery.
Our search did not retrieve any randomized comparison of tubal surgery versus expectant management or IVF measuring live birth or pregnancy in women with tubal infertility. This answers the first research question of the present thesis.
Our appraisal of the evidence on the effectiveness of hysteroscopy in treating subfertile women has identified limited evidence for a benefit in women with endometrial polyps before IUI and in women with primary subfertility and at least two failed IVF attempts; moreover many knowledge gaps have been identified. The use of any barrier gel following operative hysteroscopy in subfertile women might be considered: its use may decrease the formation of adhesions as well as their extent and severity but data on the key reproductive outcomes are lacking. This answers the second research question of our thesis.
Our research has demonstrated an increase in the number and an improvement in the methodological quality of published RCTs on reproductive surgery over recent years. This answers part of the third research question of the present thesis.
There is a move towards identifying and accumulating the highest quality evidence; inevitably, this should lead to a greater use of this evidence in the field and bridge the gap between evidence and daily clinical practice. Do we need more or rather less EBM in this field? The pros and cons of evidence-based practice in reproductive surgery are discussed in the final section.