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Hysteroscopy and laparoscopy are part of the global management of the patient. The diagnostic performance of hysteroscopy is undisputed for the uterine cavity itself. On the therapeutic side, there are reports that show a significant improvement in fertility results after hysteroscopic surgery of intrauterine conditions, although this is not always the case. These findings, together with the simplicity of the office procedure, make a strong case in favor of routine investigation of the uterine cavity by hysteroscopy before entering an assisted reproductive technology (ART) program. Laparoscopy requires general anesthesia in the majority of cases. There are conditions that indicate laparoscopic treatment prior to in vitro fertilization (IVF). More and more randomized controlled trials (RCTs) demonstrate that treating the patient before IVF improves the results of assisted procreation. Indications for a laparoscopic treatment do not differ before IVF from what they would have been without use of IVF.
In vitro fertilization (IVF) has completely changed the field of reproductive medicine. More than 80% of oocytes were reported to resume meiosis independent of the menstrual cycle day and gonadotropin support in in vitro maturation (IVM) medium. Collection and IVM of these already existing immature oocytes provides multiple metaphase II (MII) oocytes that can be fertilized in vitro. Young women with high antral-follicle counts achieve the highest pregnancy rates with IVM. Therefore, IVM is considered an established treatment option for women with polycystic ovaries (PCO) or polycystic ovarian syndrome (PCOS) who need treatment with assisted reproductive technologies (ART). Age of the woman and the number of oocytes collected are the two most important determinants of pregnancy following an IVM cycle. Young women with PCO are the best candidates for IVM treatment. IVM is a relatively new technology and clinical experience with this technique is limited compared to conventional IVF.