Surgical Evaluation of Infertility

Surgical Examination for Infertility Diagnosis & Treatment

Some patients may benefit from having their physician perform a laparoscopy and/or a hysteroscopy.

Laparoscopy involves placing a thin camera through the belly button. A laparoscopy can be used to evaluate and treat endometriosis, scar tissue, and certain fibroids. Alternatively, a hysteroscopy involves placing a thin camera inside the uterus. It is helpful for diagnosing and treating such things like a uterine septum, polyps, or certain fibroids. Both of these procedures are outpatient and can be done concurrently if necessary.

 

Laparoscopy

A laparoscopy is an outpatient procedure which is commonly performed by infertility specialists. During this outpatient procedure, 2-3 small incisions are made in your belly button and in your lower abdomen. Your abdomen is then inflated with carbon dioxide in order to allow the abdominal and pelvic organs to separate from each other, creating a space in which the surgeon can work. An operative telescope (laparoscope) is then inserted through the belly button incision to allow your surgeon to view the pelvic cavity, including your uterus, fallopian tubes, ovaries, and surrounding tissues.

If there is evidence of endometriosis, laser therapy can be used to treat the disease. Cysts can also be removed from the ovaries during laparoscopy. If there is evidence of scar tissue, this can be treated or removed as well. The patency (‘openness’) of the fallopian tubes can also be established during laparoscopy by injecting dye into the uterus and watching for spillage from the ends of the fallopian tubes.

Most laparoscopic procedures take between 1-2 hours to complete. Following surgery, a patient needs a few hours of recovery before being discharged home with pain medications. It is recommended that you take a few days off after surgery for full recovery before returning to your normal activities. More extensive procedures may require a longer recovery.

We typically recommend laparoscopy for patients who complain of severe cramping with their periods, painful intercourse, pelvic pain unresolved with mild analgesics, and for patients who have a history of previous pelvic or abdominal surgery. We also recommend this procedure for patients who have a history of having had a pelvic infection or patients who have any abnormality on their physical examination, HSG, or vaginal ultrasound exam.

Hysteroscopy

A hysteroscopy is similar to a laparoscopy in that a thin camera is used. However, during a hysteroscopy, the camera is placed through the vaginal opening into the uterus without making any incisions. A small amount of fluid is placed in the uterus to allow the surgeon to adequately visualize the uterine cavity. At this time, any fibroids, polyps, or scar tissue that is present, may be removed. A uterine septum (an abnormal band of tissue that extends from the top of the cavity into the lower part of the uterus) can also be removed during a hysteroscopy.

Following surgery, a patient will spend a few hours in the recovery area before discharge. Typically, a patient will make a full recovery within 24-48 hours. Unlike laparoscopy, hysteroscopy can be performed under IV sedation rather than general anesthesia, leading to a quicker recovery.

We typically recommend hysteroscopy to patients who have any intrauterine abnormality on a transvaginal ultrasound examination or HSG. We also recommend it for patients who have persistent spotting before their menstrual flow actually begins, for patients who have a thin midcycle uterine lining, or for patients who have previously failed to get pregnant with IVF despite a normal stimulation and good quality embryos.