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I suggest consideration of a pelvic evaluation (laparoscopy and hysteroscopy) when the entire (presurgical) infertility evaluation is normal, all identified abnormalities have been optimized (with a reasonable course of treatment) without apparent restoration of fertility, the couple is considering controlled ovarian hyperstimulation or In Vitro Fertilization, or a surgically correctable reproductive abnormality is identified on hysterosalpingography.
Pelvic evaluation allows the fertility surgeon to assess the pelvis directly. At this time most cases of endometriosis, pelvic adhesions, and anatomic abnormalities can be repaired. Restoration of reproductive potential is related to the extent and nature of the (preoperative) damage and the surgical expertise of the operating physician.
There is an extraordinary range of surgical expertise among physicians performing operative laparoscopy and hysteroscopy. Generally, a couple that needs to consider surgical repair of the pelvis should carefully consider the reputation (in the medical community) and the surgical talents (training and experience in operative laparoscopy and hysteroscopy) of each of the physicians (surgeons) available locally. Repair is always easiest (with the greatest potential for success) during the initial operation (attempt).
A detailed discussion of this type of surgery is presented in the tutorial on infertility procedures.
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