Sometimes, anatomical problems may be the cause of infertility. If your physician suspects this is the case, reproductive surgery may be the recommended initial treatment to improve the chances of conception. The various surgical techniques include hysteroscopy, laparoscopy or laparotomy (see below for details).
- Endometriosis - The treatment of endometriosis depends upon its severity. If the endometriosis and symptoms are severe, you may require surgery to remove the endometriosis. The treatment may involve laparoscopy. In this procedure, two to four small incisions are made in the lower part of the abdomen and a laparoscope, a tiny camera, is used to examine the pelvic cavity. The endometriosis is removed using microsurgical techniques.
- Adhesions - Adhesions are areas of scar tissue that can occur within the uterus or the pelvis. Pelvic adhesions may be diagnosed and treated with laparoscopy. The laparoscope is inserted into the pelvic cavity through a tiny incision made just below the woman's navel.Adhesions in the uterus may be diagnosed using an x-ray procedure called hysterosalpingography (HSG) or an ultrasound technique known as hysterosonography (HSN). Once diagnosed, a surgical procedure known as hysteroscopy may be used to remove the adhesions. During this procedure, a hysteroscope (a thin telescope-like instrument) is inserted through the cervix to view the uterine cavity. The adhesions may then be removed using microsurgical techniques.
- Fibroids - A hysterosonogram may be conducted to detect if there are any fibroids. During this procedure, a small amount of sterile saline is injected into the uterus by passing a small catheter through the cervix. An ultrasound is then performed. This test is usually done in the office. Twenty percent of women have fibroids and most do not need surgery. Generally, only fibroids that are in the uterine cavity need to be removed. Myomectomy is the name for the surgical procedure in which the fibroid tumor or tumors are removed. The number, size, and location of the fibroid(s) are some of the variables based on which the type of surgery to be performed is selected. For small fibroids that are within the uterine cavity, your physician may recommend operative hysteroscopy. For patients with large and or multiple fibroids, major surgery involving opening the abdomen with an incision (laparotomy) may be recommended. Sometimes, a less invasive procedure called laparoscopic myomectomy is possible. This procedure offers a much shorter recovery time.
- Hydrosalpinx - In patients with severe tubal disease the tubes may be swollen like a balloon (hydrosalpinx). Patients with hydrosalpinges usually require surgical treatment which may involve repair (tuboplasty) or removal of the tubes (salpingectomy). Recent research has confirmed that hydrosalpinges have a negative impact on success rates with IVF. Your physician, therefore, may recommend tubal surgery prior to an IVF attempt.