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The FIGO Committee on Reproductive Endocrinology and Infertility reviewed current literature to develop recommendations for fertility\u2010sparing surgical management. Effective treatment must balance disease control with fertility preservation. Evidence supports refined surgical techniques and alternative methods that minimize reproductive harm. In pregnancy loss management, medical treatment is preferred; however, if surgery is needed, hysteroscopic evacuation is safer than sharp curettage, reducing the risk of intrauterine adhesions. Similarly for other operative hysteroscopic procedures or abdominal procedures, including myomectomy, the use of an adhesion\u2010reducing substance is recommended. During abdominal myomectomy, only symptomatic or fertility\u2010impairing fibroids should be removed, as excessive resection may reduce pregnancy chances. In endometrioma surgery, preserving ovarian tissue is crucial by minimizing stripping of the pseudocapsule, or using sclerotherapy may help. Oocyte cryopreservation should be discussed when recurrence or reduced ovarian reserve is a concern. Hydrosalpinx often requires salpingectomy to enhance in\u00a0vitro fertilization outcomes, but surgeons should protect ovarian blood flow by minimizing thermal injury. For adenomyosis, medical management is preferred due to the risks associated with surgical techniques like the triple\u2010flap procedure. In polycystic ovary syndrome, laparoscopic ovarian drilling is discouraged; ovulation induction with letrozole or gonadotropins is safer and effective. In summary, fertility\u2010sparing treatment demands personalized, evidence\u2010based strategies that prioritize reproductive potential while managing disease. As reproductive goals evolve, continued refinement of these approaches remains vital to women's health care.<\/jats:p>","DOI":"10.1002\/ijgo.70546","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T14:03:52Z","timestamp":1758722632000},"page":"1022-1028","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Gynecologic surgery for benign disease: Preserving reproductive potential"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5253-2565","authenticated-orcid":false,"given":"Togas","family":"Tulandi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Rotunda Hospital  Dublin Ireland"},{"name":"Royal College of Surgeons in Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Purandare","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Galway University Hospital  Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Medicine, Dentistry and Nursing University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eytan R.","family":"Barnea","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Dolmo Carluccio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif Goknur","family":"Topcu","sequence":"additional","affiliation":[{"name":"Sisli Kolan International Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dov","family":"Feldberg","sequence":"additional","affiliation":[{"name":"Helen Schneider Hospital for Women Rabin Medical Center  Petah Tikva Israel"},{"name":"Tel Aviv University School of Medicine  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"FIGO Committee on Reproductive Endocrinology and Infertility","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"e_1_2_17_2_1","unstructured":"UpToDate.https:\/\/www.uptodate.com. 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