Surgery can sound scary. Thinking about anesthesia, recovery time and potential pain can send anyone into a full-fledged panic attack. For some infertility patients, however, we recommend surgical intervention as the best option for both the diagnosis and treatment of your condition. The good news is that side effects and recovery times have significantly improved and benefits vastly outweigh the risks.

Here are several reasons why surgery may be the best approach before proceeding with intrauterine insemination or in vitro fertilization (IVF):

  • Both women and men can benefit from surgeries that will allow natural conception now and in the future
  • Surgery is an effective way to diagnose and treat endometriosis, polyps, fibroids, pelvic infections and/or uterine or tubal abnormalities.
  • Surgery can help alleviate some of the symptoms of these conditions, such as heavy menstrual bleeding and pain.
  • Surgeries can provide a more comprehensive diagnosis before proceeding to IVF.
  • Modern advances in surgical techniques are significantly reducing its invasiveness, the side effects of anesthesia and recovery time.

For patients trying to get pregnant, some of the more common gynecological surgeries performed by reproductive endocrinologists are:

  • Hysteroscopy
  • Laparoscopy
  • Myomectomy
  • Tuboplasty
  • Microsurgical tubal reanastomosis

We refer male patients who need either a varicocele (testicular) repair or vasectomy reversal to a male fertility specialist/urologist.

Hysteroscopy
A hysteroscopy is used to examine the inside of the uterus and involves no incisions. A diagnostic hysteroscopy is performed in the office, usually taking 10 minutes without anesthesia. The doctor inserts a hysteroscope (a thin, fiber optic lighted telescope) through the cervix and into the uterus after the cervix is dilated. Carbon dioxide is used for expansion of the uterine cavity and visualizing its internal structure.
If we suspect there will be fibroids or polyps requiring removal, we recommend an operative hysteroscopy or laparoscopy so the issue can be corrected without the need for a second surgery.

Laparoscopy
Laparoscopic surgery explores the outside of the uterus, ovaries and fallopian tubes. A small incision is made in your belly to inflate it with carbon dioxide gas and then a laparoscope, similar to a telescope, is inserted. This allows us to inspect your reproductive organs and pelvic cavity, and to look for cysts, adhesions, fibroids, infections, uterine malformations, such as a septum wall, endometriosis or an ectopic pregnancy. Samples for biopsy can also be collected at the time. This type of ‘keyhole’ surgery minimizes scarring to the abdomen and reduces recovery time.

Myomectomy
This is for the surgical removal of fibroids from the uterus. The uterus is left in place and, hopefully, makes pregnancy more likely than before.

Tuboplasty
This term broadly refers to several types of surgical operations to restore ‘flow’ or patency to the fallopian tubes with the goal of recreating normal functioning. A salpingostomy creates a new opening at the end of the fallopian tube; and salpingolysis is how adhesions are removed from around the tube. These operations are not as commonly performed, with many patients preferring IVF.

Microsurgical tubal reanastomosis
If a woman has had a previous tubal ligation to ‘tie her tubes’ to prevent pregnancy, she may want to restore their functioning. Often the success of reanastomosis or untying of the tubes depends on the type of surgery performed originally. Couples often decide between this and using IVF to build their family, depending on the age of the woman and how many additional children she is hoping to have.

Though there is a growing trend to bypass surgeries unless it is absolutely necessary, certain operations are warranted depending on patient age, diagnosis, finances and goals. Plus new, state-of-the-art surgical procedures and instruments are making surgeries easier and faster for a more pain-free and quicker recovery.

Sources
http://www.webmd.com/digestive-disorders/laparoscopy-16156

https://www.asrm.org/BOOKLET_Laparoscopy_and_Hysteroscopy/

https://www.fertilityauthority.com/tests-and-medications/surgical-tests-hysteroscopy-and-laparoscopy