[Tubal sterility. Attempt at cost-benefit comparison between in vitro fertilization and surgery]

The choice that exists when confronted with a case of tubal sterility that can be operated on between in vitro fertilisation straight off or surgery is an example where an analysis of the cost effectiveness may help to make the medical decision. This should, however, depend on several parameters that can not be calculated, such as the other factors in the infertility, the ability for other techniques to be applied, and what the couple want. When the expected success rate for surgery is less than 25 to 35% at present, given the results that are obtainable by in vitro fertilisation surgery is contra-indicated. On the other hand, when the tubal surgery results are expected to be good, and given the introduction of new surgical techniques above 50% success rate, for the next few years at least there are excellent indications to operate. In the distant future it is probable that reversal of sterilisation which gives good operative results will stay as an operation, while tubal blocks that are due to infection will have to resort to in vitro fertilisation, although if laparoscopic surgery can be carried out that might be preferable.