Gynaecologists are frequently involved in the management of conditions that may result in reduced fertility or treatments they administer can lead to infertility. Sexually transmitted infections and pelvic inflammatory disease are the most common cause of tubal damage. Gynaecologists can play an important role in the identification and early treatment of these diseases. Pelvic surgery for conditions such as leiomyoma, ovarian cysts and endometriosis can lead to pelvic adhesions and iatrogenic infertility. By avoiding unnecessary operations by careful assessment of women with these conditions and by identifying those who can be managed without surgery, the future risk of infertility can be avoided. When surgery is clinically indicated, primary prevention of pelvic adhesions would be of paramount importance. A reliable surgical technique and the use of anti-adhesion agents may reduce the development of pelvic adhesions. Ovarian surgery for endometriomas and other benign cysts should be performed in the hands of experienced surgeons or in 'centres of clinical expertise', and maximum efforts should be made to preserve normal ovarian tissue as much as possible.