Infertility specialists are not only clinicians; they are also surgeons. Infertility surgical procedures can help to correct many fertility problems and anatomical abnormalities that may lead to infertility or pregnancy losses. Here, we list the most common types of surgical procedures performed by fertility specialists.
If anatomical problems interfere with your ability to conceive or maintain a pregnancy, infertility surgery may be recommended. Common indications for surgery include the following:
- Blocked fallopian tubes
- Polycystic ovary syndrome (PCOS)
- Adhesions (scar tissue).
- Reversals of sterilization procedures for men and women
During an operative hysteroscopy, under general anesthesia, a small hysteroscope (a fiber optic telescope) is inserted through the cervix and advanced into the uterine cavity. This procedure allows for direct views of the uterine cavity and permits the physician to surgically correct the abnormality. Patients go home the same day as the procedure and can often return to work the next day.
Damaged or blocked fallopian tubes can cause fertility problems. Thankfully, surgical procedures can heal blockages in the tubes, helping women with tubal issues get pregnant. Tubal surgery can also reduce scar tissue build-up in the fallopian tubes, restoring tubal health and fertility. However, for chronically damaged tubes after tubal disease, tubal surgery fails quite often. Scar tissue often reforms, and in vitro fertilization (IVF) may be a better option for those women who are trying to conceive. Ask your doctor for more details about this surgery option.
Laparoscopy, a minimally invasive surgery, often requires only a few 0.5 cm incisions through the abdominal wall. The surgeon inserts a laparoscope, a small fiber optic telescope, into the abdomen through these small incisions to view and make surgical corrections to the pelvic structures involved. Operations can take as little as 20 minutes to many hours, depending on the extent of the problem. Laparoscopy is a less-invasive procedure than open abdominal surgery and allows for a quicker recovery with a lower risk of adhesion (scar tissue) formation. Most patients go home the same day as the procedure and return to work 3 to 4 days later.
Success rates for laparoscopy are conflicting, and vary based on severity. Notice the following:
- About 60 to 80 percent of women undergoing laparoscopy as treatment for endometriosis report reduced pain and bleeding after surgery.
- Women with severe endometriosis (Stage III/IV) can benefit from surgery for endometriosis depending on several factors. Benefits of laparoscopy for women with minimal or suspected endometriosis are far less certain.
- For mild endometriosis, at least one study has shown that for every 12 patients undergoing surgery for endometriosis, only one patient was able to achieve a pregnancy.
- For women with previous surgery for endometriosis, it has been reported that additional surgery has NOT been shown to improve pregnancy rates.
Overall, surgery for a woman who is diagnosed with a few spots of endometriosis may not benefit as much as a woman with a severe case of endometriosis.
The only sure way to diagnose endometriosis is with surgery such as laparoscopy. The surgeon may use either laparoscopy (outpatient surgery) or a laparotomy, which requires an abdominal incision and hospitalization. Both laparoscopy and laparotomy can help diagnose endometriosis and remove abnormal tissue and adhesions. Oftentimes, laparoscopy and laparotomy will help a woman conceive on her own without requiring additional fertility treatments.
When fertility problems affect the uterus, surgery can help to restore your fertility. Uterine surgery can correct blockages and abnormal tissue growth and remove scar tissue and fibroids. Surgery can also help repair an abnormally shaped uterus. A surgery called hysteroscopy may help, reducing miscarriage rates and leading to a healthy pregnancy.
Open Abdominal Procedures
The most common type of abdominal procedure performed by infertility specialists is an abdominal myomectomy, the removal of large uterine fibroids. Most open abdominal procedures require at least 1 or 2 nights of hospitalization. Most patients return to work within 4 to 6 weeks
Ovarian drilling is a laparoscopic procedure performed under general anesthesia. The surgery is typically done on an outpatient basis with minimal recovery time. Ovarian drilling is a surgical procedure that breaks through the ovary’s thick outer layer, destroys small portions of it, boosting fertility.
Here is how ovarian drilling works:
- Your surgeon makes a small incision below your belly button.
- He or she inserts a tube into your abdomen, filling it with carbon dioxide. This inflates your abdomen and prevents damage to your internal organs.
- A thin telescope with a camera attached is inserted into your abdomen, allowing your surgeon to view your internal organs and ovaries. Guided by the camera, the surgeon inserts special tools and uses an electric current to make very small holes on your ovaries.
After ovarian drilling, testosterone production decreases and many women ovulate more regularly. Here are some facts about pregnancy success after ovarian drilling:
- If your periods become regular after ovarian drilling, your chances of pregnancy are good. Those whose cycles do not become more regular may have better success in getting pregnant with the help of fertility drugs.
- About half of all women that go through with ovarian drilling become pregnant within one year.
- For some women, the benefits of ovarian drilling are short-lived. PCOS symptoms and fertility problems may return over time, and your periods could become irregular again.
Some men and women choose surgical sterilization when family building is complete. Many women opt for tubal ligation, also called tying the tubes. Men often choose vasectomy. A woman may choose to have her tubal ligation reversed while a man may choose vasectomy reversal. These reversals offer many individuals another chance to become parents.
Most infertility surgeries are outpatient procedures that do not require overnight stays in the hospital. Still, the decision to proceed with surgical treatment to improve fertility is complex. Multiple factors need to be considered to optimize your chances for pregnancy.
The risks and benefits of infertility surgery must be weighed by you and your treatment team on an individual basis. Each person’s scenario is different so you must do what is best for your situation.