Laparoscopy allows for the comprehensive evaluation of the pelvis and uterus including confirmation of tubal patency and evaluation of tubo-ovarian relationships. Laparoscopy represents an effective alternative to artificial reproductive technology (ART) for women with tubal disease/hydrosalpinx, leiomyoma, endometriosis, and/or unexplained infertility. Diagnostic laparoscopy combined with operative endoscopic procedures allow prompt and complete identification of all contributory factors, helping the physician to institute appropriate therapy, and will help ensure higher conception rates over shorter intervals. In the recent era of evidence-based medicine, it is recommended that a multicentric prospective randomized study is needed to prove the efficacy of laparoscopic evaluation in predicting the fertility outcome in patients experiencing infertility. Careful selection of patients based on clinical history as well as physical examination and non-invasive laboratory techniques will identify those patients most likely to benefit from endoscopic examination for their infertility evaluation.