The management of tubal disease depends on the initial pathological process and the severity of damage. In vitro fertilisation (IVF) remains the main treatment strategy for women with severely damaged fallopian tubes. The main causes of tubal factor infertility include previous tubal infection, previous surgery, endometriosis and congenital abnormalities. Infection, endometriosis and surgery affect tubal function via different mechanisms but all lead to inflammation. Classification of tubal disease is essential for use in clinical trials but also as a potential prognostic indicator to assist patients and clinicians in decisions regarding further management. The tubal disease is classified into grade I - minor, grade II - intermediate or moderate and grade III - severe. Once tubal disease has been identified, management options include expectant management, tubal cannulation, surgery and IVF. Several prognostic factors need to be considered when counselling women regarding their individual further management options.

The success rate of tubal anastomosis, measured as the rate of intrauterine gestations after surgery, is generally quite high, especially if there is an appropriate patient selection and evaluation prior to surgery. Laparoscopic technique of tubal anastomosis was developed in 1998 after many years of performing minilaparotomy and traditional microsurgery in several hundred cases. A specially designed, malleable, tubal cannulator is introduced through the cervix and guided to the proximity of the tubal ostia under laparoscopic control. The stent facilitates the performance of the laparoscopic tubal anastomosis tremendously. The laparoscopic approach is essentially identical to that of the open-abdomen technique except for the use of specialized instrumentation to facilitate its performance via laparoscopy. A proper preoperative evaluation of the ovarian reserve and male factor are important determinants as to whether the patient will be best served by having a laparoscopic tubal anastomosis or in vitro fertilization.