Some causes of infertility can be corrected using reproductive surgery. Many women have gynecological conditions that pose serious threats to fertility. For these cases, many couples seek out the assistance of a fertility specialist or reproductive surgeon. A reproductive specialist who performs surgery is a fellowship-trained endocrinologist who specializes in simple procedures and minimally invasive surgery.
Types of Minimally Invasive Surgery
Our primary goal is for the patient to have the best possible surgical result from the least invasive procedure. We strive to use minimally invasive surgery with specialized instruments, surgical scopes, fiber-optic lights, and high-definition monitors. This technology allows our reproductive surgeons to perform conventional procedures through small incisions or the vagina.
Hysteroscopic Surgery – Many uterine conditions can be corrected using hysteroscopic surgery. These include myomas (fibroids), scar tissue, polyps, and congenital growths. Hysteroscopic surgery allows the patient to go home the same day. A small camera and tools are inserted through the cervix without incisions.
Laparoscopic Surgery – With this procedure, 2-3 small incisions are made along the lower abdomen and pelvis. The incisions are about ¼ – ½ inch long. Conditions treated using laparoscopy include endometriosis, scar tissue, adhesions, larger fibroids, ovarian cysts, and damaged fallopian tube.
Myomectomy – This procedure involves removal of fibroids (myomas) from the uterus. Around 30-40% of women are affected with myomas in the later reproductive years. Patients who wish to become pregnant often consider surgery if the myomas cause heavy or irregular menstrual flow. The operation is often performed using laparotomy and a small transverse incision.
Tubal cannulation – With this procedure, a small catheter is guided through one or both fallopian tubes to help remove a blockage. Small tools can be used to make repairs. This procedure is often done along with a hysterosalpingogram, which involves injecting dye to identify blockages.
Microsurgical tubal reanastomosis – This procedure is used to reverse a tubal ligation (tubes tied). A mini-laparotomy incision (bikini-cut) is made to insert a small scope. Tubal reanastomosis has a success rate of approximately 60-80%. However, tubal reversals for women over the age of 37 years are rarely effective, so IVF is recommended.
Benefits of Minimally Invasive Surgery
Unlike conventional open surgery, minimally invasive approach offers less stress and trauma to the body. No large incisions are made, and retraction is not necessary. For the surgical patient, this means fewer complications, less pain, smaller surgical scars, less blood loss, and a quicker recovery. For most patients, the surgery is outpatient, and they go home the same day. Benefits of minimally invasive surgery include:
Less blood loss
Fast return to normal activities
Better cosmetic results
Causes of Infertility treated with Reproductive Surgery
Endometriosis – Treated with laparoscopic excision, ablation of endometriosis, lysis of adhesions, robot-assisted laparoscopy, and prophylactic appendectomy.
Developmental abnormalities – Includes uterine septum, uterine horn, imperforate hymen, and vaginal septum. Treated with laparoscopic resection.
Polycystic ovarian syndrome (PCOS) – Treated with ovarian wedge resection and laparoscopic ovarian drilling.
Anatomical abnormalities of the uterus
Uterine bleeding – Treated with dilation and curettage, operative hysteroscopy, endometrial ablation, cryoablation, and laparoscopic assisted vaginal hysterectomy.
Reversal of tubal ligation – Treated with microsurgical tubal reanastomosis.
Fibroids – Treated with hysteroscopic myomectomy, laparoscopic myolysis, laparoscopic myomectomy, and abdominal myomectomy.
Ovarian cysts – Treated with laparoscopic oophorectomy and laparoscopic ovarian cystectomy.
Asherman’s syndrome – Treated with hysteroscopic lysis of adhesions.