Gynecologic surgery for benign disease: Preserving reproductive potential

Preserving fertility is essential when managing benign gynecologic disorders in reproductive-aged women. Surgical interventions can impact future fertility, therefore requiring an evidence-based, individualized approach. The FIGO Committee on Reproductive Endocrinology and Infertility reviewed current literature to develop recommendations for fertility-sparing surgical management. Effective treatment must balance disease control with fertility preservation. Evidence supports refined surgical techniques and alternative methods that minimize reproductive harm. In pregnancy loss management, medical treatment is preferred; however, if surgery is needed, hysteroscopic evacuation is safer than sharp curettage, reducing the risk of intrauterine adhesions. Similarly for other operative hysteroscopic procedures or abdominal procedures, including myomectomy, the use of an adhesion-reducing substance is recommended. During abdominal myomectomy, only symptomatic or fertility-impairing fibroids should be removed, as excessive resection may reduce pregnancy chances. In endometrioma surgery, preserving ovarian tissue is crucial by minimizing stripping of the pseudocapsule, or using sclerotherapy may help. Oocyte cryopreservation should be discussed when recurrence or reduced ovarian reserve is a concern. Hydrosalpinx often requires salpingectomy to enhance in vitro fertilization outcomes, but surgeons should protect ovarian blood flow by minimizing thermal injury. For adenomyosis, medical management is preferred due to the risks associated with surgical techniques like the triple-flap procedure. In polycystic ovary syndrome, laparoscopic ovarian drilling is discouraged; ovulation induction with letrozole or gonadotropins is safer and effective. In summary, fertility-sparing treatment demands personalized, evidence-based strategies that prioritize reproductive potential while managing disease. As reproductive goals evolve, continued refinement of these approaches remains vital to women's health care.