The Independent of may 16th wrote “IVF clinics accused of putting money before safety”

Infertility treatment in addition is complicated by another even bigger problem which causes avoidable costs and physical suffering for women seeking infertility treatment.
As explained in 2004 when receiving the “Distinguished surgeon award” of the ASRM the introduction of laparoscopic surgery had a fundamental impact upon fertility surgery
- Fertility surgery used to be done by microsurgery and thus remained centralized. With the introduction of laparoscopic surgery in the early 90-ies fertility surgery became mainstream and the quality went down. Simultaneously
the number of IVF cycles went up.
- Today infertility units with excellent surgery have become rare. Most of the infertility centers have become IVF centers.  When attending meetings as ASRM or ESHRE this discrepancy between emphasis on surgery and IVF is obvious.
- We should moreover realize that in surgery there is no quality control of the individual intervention. For this reasons I wrote that video-registration should become mandatory especially in infertility surgery which should maintain and restore function

Being aware of the underlying problems I therefore made in 2004 Philadelphia the following recommendations

First infertility treatment needs a quality control.
Since surgery is the first line of treatment, video-registration of the entire intervention and quality control should be mandatory.
IVF should be organized as service centers but should not make the decision to start IVF treatment;  the choice of treatment should be made by somebody else (this is similar to radiologic exams that have to be prescribed by others)  Otherwise the judgement of IVF centers could become biased with the actual end result that IVF is used too easily while  becoming an alibi for not paying too much attention to the quality of surgery.

And I  concluded : “since a surgery-child is moreover some 5 to 10 times less expensive than an IVF child, if I would be minister of health, I would put my money on surgery but with a quality control. This way I will help women to get a child while saving money”

Today 8 years later I do realize that nothing has changed ; on the contrary things have become worse.  The advice to patients with infertility therefore is twofold

• check the surgeon and the quality of surgery performed in the fertility center you are attending.
• be very prudent when a surgeon refuses to show what he does, by refusing to make a video-registration of the entire intervention with a copy to you.
• the better IVF units today have an agreement with skilled surgeons

Prof em PR Koninckx  and Drssa A. Ussia

KU Leuven Belgium,  Univ of Oxford, University of Rome ; honorary consultant UK ; Gruppo Italo Belga