For Patients Infertility Explained Surgical Options Surgical Options
In recent years, microsurgery – an operation using the magnification of an operating microscope or a laparoscope – has led to dramatic advances infertility treatments. With microsurgery, a gynecologic surgeon can correct problems that previously were considered incurable, including fertility enhancing surgery.
Microsurgery also involves very fine suture materials that minimize skin irritation and delicate tissue handling techniques. An operating microscope allows magnification from two to 30 times, providing excellent visualization. A laparoscope is similar to a telescope that is inserted into the pelvic cavity through a small incision in the navel, greatly enhancing lighting and visualization.
Pelviscopy refers to a special type of operative laparoscopy in which more extensive procedures are performed. Laparoscope lenses provide magnification, and video monitoring may allow a surgical assistant to work as one with the surgeon. Pelviscopy can effectively treat an ectopic pregnancy, uterine fibroids, ovarian cysts and tumors, endometriosis, and pelvic adhesions.
Pelviscopy, when used properly, offers numerous advantages. The surgeon can avoid an open abdominal incision, allowing an outpatient procedure, minimizing discomfort and leaving no visible surgical scar. Most importantly, in many cases the laparoscopic approach produces better results than other types of surgery, probably as a result of decreased tissue trauma and less adhesion formation.
Microsurgery for Reversal of Sterilization
A recent survey indicated that more than 12 million people in the United States have been sterilized, and more than 60 percent of those procedures are performed on women. Approximately 15,000 to 20,000 of sterilized women eventually want to reverse the procedure because of a renewed desire for children.
Microsurgical techniques can repair fallopian tubes with excellent results. At RSC, women who have had reversal surgery can anticipate a term-pregnancy rate of 75 to 80 percent if at least 4 centimeters of the fallopian tube remains.
Fibroid Removal
Some women experience infertility as a result of benign (non-cancerous) uterine fibroid tumors [link]. Laparoscopy and hysteroscopy are two approaches for removal of fibroids, known as myomectomy. Until recently, surgical removal of fibroids often involved a large abdominal incision (laparotomy) with a three-to-five day hospital stay and six-to-eight week recovery.
Surgery for Endometriosis
In surgical treatment of endometriosis, a physician removes endometrial implants and scar tissue by cutting away, cauterizing (burning), or vaporizing with a laser. The surgery can usually be done during laparoscopic inspection. Physicians today often use high-tech techniques such as surgical lasers and ultrasonic scalpels to increase accuracy and decrease trauma to nearby tissues. This leads to better post-operative healing and better results.
Ectopic Pregnancy
In a normal pregnancy, a fertilized egg travels from the fallopian tube to the uterus for implantation. But in 1 to 2 percent of pregnancies, it attaches to any area outside the uterus, where – if left untreated – it can damage the fallopian tube and possibly even become life threatening.
Microtubal Reversal Surgery
Many women who have borne children decide to have a tubal ligation (“having your tubes tied”) as a means of contraception, thus blocking a fertilized egg from passing to the uterus for implantation. However, some have a change of mind later and wish to have the procedure reversed. A specially trained surgeon can perform a reversal through a microsurgical tubal reanastomosis, or microsurgical tubal repair, or MTR – a procedure that enables a patient to avoid hospitalization
Hydrosalpinx Removal
Once hydrosalpinx [link to Female Structural Causes] has been diagnosed, the physician and patient discuss optimal treatment. In some cases, proceeding immediately to in vitro fertilization [link] (IVF) may be the most efficient route to pregnancy. For others, surgery to repair or remove the fallopian tube will render the best results.
