Major indication to be considered for IVF is tubal infertility which cannot be treated with microsurgery, i.e. the natural place of fertilization, the Fallopian tube, is not functioning or has been removed. Disturbance of tubal function is one of the most common causes of involuntary childlessness.
The main reason for tubal infertility is inflammation of the pelvis by ascending bacteria, endometriosis and peritubal adhesions caused by operations, intrauterine contraceptive devices or ectopic pregnancies. Tubal infertility is treated either by microsurgical reconstruction (Decleer et al., 1990) or by in vitro fertilization and embryo transfer. Different criteria have to be taken into account and the therapy should be chosen which leads prospectively and quickly to pregnancy and birth. It is possible to state the success rate per treatment cycle when using IVF in spite of the heterogeneity of patients and indications, whereas this is almost impossible for microsurgical operations. For a successful operation, the size and type of the tubal defect, the experience of the surgeon and the technique used are very important. Therefore, it is almost impossible to state a success rate for all indications.
Additional factors influencing the decision are the age of the patient, the duration of infertility, the possible danger of tubal pregnancy and the attitude of the patient towards the new treatments.
In case of male infertility, the gynecologist would first recommend intrauterine insemination by trying to promote contact between the oocyte and the spermatozoa. The success of this treatment is influenced by various factors. First, attempts may be made to bring selected and capacitated spermatozoa as close as possible to the site of fertilization in the ampullary part of the tube by intrauterine insemination at the time of ovulation in an adequate cycle. If a pregnancy has not occurred after five to six treatment cycles and considering the factors mentioned above, in vitro fertilization is justified for cases with an andrological disturbance.
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