Surgical correction of disorders of the reproductive tract has long been a mainstay of in fertility therapy. With the advent of IVF, however, many reproductive endocrinologists are moving away from surgery except as an adjunct to assisted reproduction techniques (ART). Depending on the condition, ART may provide a higher success rate in a shorter period of time. However, when IVF is not an option, surgery remains an important treatment for such things as endometriosis and pelvic adhesions (scarring). The most frequently performed surgical procedures are outpatient laparoscopy (or “pelviscopy”) and hysteroscopy. Opening the abdomen (laparotomy) is most useful for removing fibroids. Because laparoscopic surgery is less likely to result in new adhesions, laparotomy is being replaced by ever more sophisticated laparoscopic techniques.
Ironically, one indication for laparoscopy in women who need IVF is the presence of a blocked dilated fallopian tube (“hydrosalpinx”). Though IVF was originally developed for women with blocked tubes, we more recently learned that the fluid contained in a hydrosalpinx can leak back into the uterine cavity and act as a toxin on embryos attempting to implant. Consequently, IVF pregnancy rates are 30-50% lower in the presence of a hydrosalpinx than in cases without a hydrosalpinx. We recommend every patient considering IVF to have an HSG to ensure the absence of a hydrosalpinx. If present, we recommend laparoscopy to either tie the tube, remove it or open the blocked end of the tube. You physician will explain the rationale for each approach.
We may also find more minor problems like endometrial polyps (small growths in the endometrial cavity) whose presence may interfere with fertility. Persistent ovarian cysts, found by ultrasound, may inhibit maximal ovarian stimulation and may need to be drained or removed via laparoscopy. Defects of the uterine cavity such as a septum or a submucous fibroid should be corrected before trying to become pregnant because they can impair implantation of embryos resulting in miscarriage of an otherwise normal pregnancy.
All of our reproductive endocrinologists are very skilled surgeons with over 20 years experience each. Dr. Letterie has authored the book “Surgery, Assisted Reproductive Technology and Infertility” now in its second edition.
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Reproductive Surgery |
