This chapter reviews the evidence surrounding the effect of reproductive surgery for tubal abnormalities, endometriosis, and uterine fibroids on in vitro fertilization (IVF) cycle outcome. Salpingectomy and proximal tubal occlusion are two surgical options in the treatment of distal tubal disease. Proximal tubal occlusion represents a significantly less invasive approach, which requires less surgical dissection and operating time while still eliminating retrograde flow of hydrosalpingeal fluid into the endometrial cavity. Consideration should be given to resection of submucosal fibroids and intramural lesions that distort directly impinge upon the endometrial cavity prior to IVF. Pregnancy rates achieved with assisted reproductive technology (ART) have increased progressively in recent years, and in endometriosis, patients achieve levels of success that are significantly higher than those obtained with alternative therapies. The prolonged use of a GnRH agonist, in at least a subset of endometriosis patients, appears to improve IVF cycle outcome.