The Role of Reproductive Surgeons

The Role of Reproductive Surgeons and the Society of Reproductive Surgeons

by Ricardo Azziz, M.D., M.P.H., M.B.A.
Published in Fertility and Sterility 2002;78:916-7.

The opinions and commentary expressed in this article are solely those of the author and are not necessarily endorsed by the Society of Reproductive Surgeons or the American Society for Reproductive Medicine.

The Society of Reproductive Surgeons (SRS) was founded in 1984 to serve as a forum for those members of the American Society of Reproductive Medicine (ASRM) with special interest and competency in reproductive surgery. The potential value of the reproductive surgeon has been highlighted by the fact that infertility due to pelvic factors in the female, including tubal disease or significant endometriosis, and surgically correctable factors in the male are present in 20% to 40% of couples (1, 2). However, since its inception, the role of the reproductive surgeon, and consequently that of the SRS, has been questioned. In the minds of many practitioners, the value of reproductive surgery has become dubious and ill defined in a world increasingly turning toward IVF for the treatment of these patients. And in fact, as acknowledged in a recent article in the SRS newsletter (3), IVF should be the preferred technique for the treatment for most women with significant tubal damage. Are we reproductive surgeons, and the SRS, then obsolete?

We should note that the SRS has not taken the indifference of our colleagues lightly. During the past two decades, many reproductive surgeons have been and are leaders in the use of operative endoscopy, and the SRS has served in the vanguard of the effort to popularize and implement the use of this technique. However, the applicability of this surgical modality has naturally and rightfully expanded beyond its use as treatment for the infertile patient, first to the general gynecologist and then to the general surgeon. Consequently, other organizations have taken over the mantle as leaders in minimally invasive surgery, including the American Association of Gynecologic Laparoscopists (AAGL) and the Society of Laparoendoscopic Surgeons. So, have reproductive surgeons, and the SRS, gone the way of the eight-track tape, the long-playing record, and the handwritten letter? Not at all! At the risk of being faulted for being an association looking for a purpose and constituency, we should note that the value of the reproductive surgeon and the SRS continues to be high. Although the role of surgery in the treatment of the infertile female and male has diminished (a fact that many patients and insurers have yet to grasp), the reproductive surgeon continues to be the expert in the conservative treatment of the reproductive organs of both men and women. In fact, antecedent abdominal, and particularly pelvic, surgery continues to be an important risk factor for tubal infertility (4, 5). For example, Tulandi et al. (6) and Lau and Tulandi (7) found that adnexal adhesions formed in the majority of patients undergoing myomectomy. Furthermore, considering that >800,000 ambulatory surgical procedures (excluding dilatation and curettages and tubal sterilizations) and 575,000 inpatient procedures (excluding tubal sterilization and hysterectomy) are performed in women of reproductive age yearly, it is also clear that the public health impact of these surgeries is significant (8, 9).

These data mandate that reproductive surgeons serve as active advocates for improving the surgical care of men and women. Consequently, the SRS will be taking the lead in the promotion of good surgical practices, particularly as they relate to the performance of conservative surgery of the reproductive organs. To this end, the SRS is supporting the improved training of reproductive surgeons through its co-sponsorship, along with the AAGL, of an Advanced Endoscopy Fellowship. The SRS is also taking the lead in improving the surgical education of the gynecologic and urologic resident by emphasizing the value of good surgical techniques and adhesion reduction for their patients and their practices. The SRS will also target the general public in these efforts by partnering with the many interested patient groups, providing them with education and information on the values of good reproductive surgery.

The SRS, through its membership, will begin creating and publicizing guidelines for good surgical practice in the per­formance of conservative surgery in women (e.g., ovarian cystectomy, myomectomy, endometriosis, adhesion preven­tion, tubal surgery, conservative surgery for ovarian cancer, vasectomy reversal, varicocelectomy for infertility, etc.). Furthermore, the SRS will begin producing patient informa­tion bulletins highlighting these guidelines, possibly in col­laboration with the Patient Education Committee of the ASRM. These materials should be disseminated by partnering with relevant professional and patient associations, interested members of industry, and directly on the SRS Web Site.

Finally, the SRS is looking beyond U.S. borders, actively embracing international members and international sister societies to help carry its educational message to the world. If there is a lesson to be learned from the senseless and tragic events of September 11, 2001, it is that we as a nation must be more proactive in promoting our message of care and concern for the quality of life of all peoples, regardless of race, religion, and most poignantly gender, and the SRS leadership understands this.

The ASRM and the SRS should not be timid in asserting their position as the homes of the world’s finest reproductive surgeons. The efforts of the SRS to establish itself as the custodian of quality reproductive-organ surgery in women and men fits well with the very successful public campaign regarding “prevention of infertility,” currently being undertaken by the ASRM. Reproductive surgeons and the SRS not only should serve as experts in the treatment of pelvic-factor infertility but should and will begin to take an activist and front-line role in improving the surgical care of men and women everywhere.

References

  1. Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed) 1985;291:1693–7.
  2. Green JA, Robins JC, Scheiber M, Awadalla S, Thomas MA. Racial and economic demographics of couples seeking infertility treatment. Am J Obstet Gynecol 2001;184:1080–2.
  3. Tulandi T. Is there still a place for surgery for distal tubal obstruction? SRS Newslett 2001;Spring:2–3.
  4. Lalos O. Risk factors for tubal infertility among infertile and fertile women. Eur J Obstet Gynecol Reprod Biol 1988;29:129–36.
  5. Bahamondes L, Romanello JG, Hardy E, Vera S, Pimentel E, Ramos M. Identification of main risk factors for tubal infertility. Fertil Steril 1994;61:478–82.
  6. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproduc­tive outcome after myomectomy and second look laparoscopy. Obstet Gynecol 1993;82:213–5.

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