Surgical Treatment of Infertility
Reproductive disorders are frequently indicative of anatomic problems of the reproductive tract that require surgical correction for optimal reproductive outcomes. Medical treatment, while sometimes available, often does not fix the problem, and repair must be undertaken directly – a surgeon must go in and remove the problem or restore the anatomy. Many of these abnormalities can be treated with minimally invasive surgery, using laparoscopy and hysteroscopy. When indicated, our surgeons will undertake operative hysteroscopy or and laparoscopy for correction of conditions such as myomectomy, Endometriosis, Polypectomy, Adhesions and Septum resection
Hysteroscopy: Hysteroscopy involves looking inside the uterus with a small camera. The cervix is dilated with a smooth dilator about the diameter of a pencil. The hysteroscope is placed through the cervix into the uterus. The uterus is gently opened with CO2 gas or a fluid. The inside of the uterus then can be seen through the hysteroscope or, more commonly, on a television screen. The surgeon can then surgically correct any anatomic abnormalites.
Laparoscopy: Laparoscopy is the classic procedure to evaluate and treat tubal disease. Under anesthesia, an incision is placed in the belly button, and a small television camera is placed through the incision. The doctor can look at the pelvic organs, investigating for signs of endometriosis, scar tissue, and cysts. Using this camera and 1 to 3 other 0.5 to 1 cm incisions, surgical correction of reproductive disorders can be performed. The advantages of minimally invasive surgery are that patients can go home the same day and resume normal activities within 1 to 2 weeks in most cases.
Fallopian Tube Abnormalities:
The fallopian tubes are the path that the sperm and egg must take to achieve fertilization and successfully implant in the uterine cavity. Disorders of the fallopian tubes can lead to the inability to conceive, because the sperm and egg cannot meet. Prior pelvic infection, surgery, or endometriosis can lead to blocked fallopian tubes. Laparoscopy is used to diagnose and treat these disorders. In some cases, severely damaged fallopian tubes must be removed to give a woman her best chance to conceive with in vitro fertilization because fluid buildup in the fallopian tubes can create a toxic environment for implantation. In other cases, pelvic scaring and endometriosis can be treated to improve a patient’s chances of conceiving naturally or with less aggressive fertility treatments.
Uterine abnormalities
The uterus or womb is the organ where the embryo implants and develops throughout a pregnancy. Uterine abnormalities can contribute to decreased fertilization, miscarriage, or pregnancy complications. Common uterine abnormalities requiring surgical treatment include polyps, scarring, fibroids and septums. Many of these abnormalities can be treated using hysteroscopy and/or laparoscopy, but some may require more extensive surgery depending on the patient’s condition. Uterine fibroids are very common among women of reproductive age and not all fibroids need to be removed in order to achieve a successful pregnancy.
Ovarian Cysts
Ovarian cysts are a frequent finding in women of reproductive age. Many of them resolve on their own and do not require surgery. Cysts that are large or persistent, lasting more than 2 to 3 months may require surgery. Most ovarian cysts are non-cancerous and may be due to endometriosis or other benign processes. Ovarian cysts can typically be removed laparoscopically, and do not require removal of the entire ovary. Other ovarian disorders, such as polycystic ovarian syndrome, can be treated medically and rarely require surgery.
Endometriosis
Endometriosis is a gynecologic condition characterized by endometrial tissue from the inner lining of the uterus, growing outside of the endometrial cavity. Typical symptoms of endometriosis are painful menstrual periods, vaginal bleeding between periods, and infertility; however, some women with infertility associated with endometriosis have no symptoms. Laparoscopy can be used to diagnose and treat endometriosis in a single procedure. .