Objective: To determine trends in female reproductive surgery volume. Design: Database analysis using the Healthcare Cost and Utilization Project databases from 1988, 1992, 1998, and 2002. Setting: Academic medical center. Patient(s): All patients who underwent reproductive surgeries using United States community hospital discharge data and inpatient and outpatient data for New Jersey (NJ) and Maryland (MD). Intervention(s): SAS statistical software was used to estimate the number of reproductive surgeries per year; weighted least squares analysis was performed to estimate trends in surgeries. Main Outcome Measure(s): Number of reproductive surgeries. Result(s): Nationally, approximately 250,000 inpatient female reproductive surgeries are performed yearly. There was a modest decreasing trend (-17%) in total reproductive surgeries, and the number of procedures with an associated diagnosis of infertility declined 79%; neither change reached statistical significance. Alternatively, a significant decline occurred in surgeries of the fallopian tubes and ovaries. Likewise, inpatient surgeries were unchanged in NJ and actually increased in MD (+13%), although outpatient surgeries declined in both states (-12% and -37%, respectively). Conclusion(s): The increased use of assisted reproductive technology (ART) has coincided with a decrease in surgeries on the fallopian tubes and ovaries. With the exception of surgery for tubal infertility, reproductive surgery has largely been complementary to, rather than replaced by, ART. © 2009 American Society for Reproductive Medicine.