Reconstructive microsurgery has been associated with significantly improved results in infertility. These techniques have made the gynecologist much more conscious of peritoneal trauma and of postoperative adhesions. It has enabled the appreciation of normal and pathologic fine morphologic details. The assimilation of microsurgical principles into gynecology will provide its major benefit in terms of prophylaxis. A pelvic laparotomy in the female infant, adolescent, or young woman will aim at conservation and the avoidance of trauma, postoperative adhesions, and future reduction of fertility. Microsurgery enables a tubal transplantation. Although this is feasible today in a homozygous twin, the wider application of this procedure must await necessary progress in immunology. Microsurgical techniques are required for extracorporeal fertilization. In the not too distant future, microsurgery will become an integral part of fertility-promoting procedures. There will no longer be the need to qualify "microsurgery" since "fertility surgery" will simply imply "fertility microsurgery."