**3. Conclusion**

In cases of tubal infertility, it is today possible to fulfill a couple's desire to have a child either by means of a reconstructive operation of the fallopian tubes or by IVF therapy. The success of treatment - even when attempted multiple times - cannot be guaranteed. In general, microsurgery and IVF therapy are not competing, but complementary therapeutic options for the treatment of tubal infertility. The definitive decision about which therapy to pursue should always be left to the affected couple after the pertinent information has been competently communicated.

The risk for EP and the chances for an intrauterine ongoing pregnancy following tubal reconstructive surgery, respectively, vary widely depending on the type, location and severity of the tubal disease and the performed surgical procedure.

The ectopic rate for mild aquired tubal disease is reported to be 1%-10% (Boer-Meisel et al., 1986; Winston & Margara, 1991; Nackley& Muasher, 1998) and for reversal of sterilization less than 10% (Practice Committee of American Society for Reproductive Medicine, 2008), but in contrast, EP rates increase up to 40% in the presence of intrinsic tubal damage, salpingitis isthmica nodosa and severe tubal pathology (Taylor et al., 2001; Posaci et al., 1999; Pandian et al., 2008; Marana & Quagliarello, 1988a, 1988b; Akande et al., 2004, Mosgaard et al., 1996). For this reason, patients with dense adhesions like frozen pelvis and a severe tubal pathology are best referred to IVF (Schippert et al., 2010).

In our own patient's collective, the EP rate following reversal of sterilization was 6.7%.

In the presence of acquired tubal disease, mainly because of previous pelvic inflammation and salpingitis, the overall EP rate was 7.9% following microsurgical reconstruction using the techniques of adhesiolysis, salpingostomy, salpinoneostomy, fimbrioplasty and anastomosis.

The risk factors for developing EP after ART still are inconsistent. The incidence is reported to be between 2.1% and up to 11% in tubal infertiltiy. The data of the Geman IVF Registry demonstrate a significantly increased incidence of EP in the presence of tubal pathology (original data from the German IVF Registry). The highest EP rate related to all pregnancies was detected to be 4.5% (95% CI: 3.0-6.0) in women <30 years who firstly had a tubal pathology, who secondly had been treated with IVF, and who thirdly smoked. If these women are non-smokers, the EP rate was 4.2% (95% CI: 3.5 – 5.0).

In summary, the risks for EP after ART and microsurgical tubal reconstruction in women with tubal infertility or tubal co-morbidity are significant and approximately comparable. Surgical tubal reconstruction still remains a significant part in the range of modern infertility treatments, however the success and/or failure of infertility surgery depends on a careful selection of appropiate patients. ART is especially recommended in women with severe tubal pathology and in the case of severe male infertility or ovarial dysfunction.
