Infertility surgery

In some cases it is necessary to carry some kind of surgery in order to diagnose or treat some infertility cases. It is generally carried out using an endoscopy (laparoscopy or hysteroscopy video), through very small incisions. This is done on an out-patient basis but that does not mean that hospitalization is not required. It is carried out under general anesthetic and recuperation is quick (5-10 days).

Used under the following circumstances:

Diagnosis:

When all initial examinations have come out as normal, the spermogram is normal and it has been clearly shown that the ovulation process is normal, etc. a laparoscopy is required to carry out a visual assessment of the reproductive organs. The uterus, Fallopian tubes, ovaries and peritoneum are examined to look for another cause which could explain the fertility problems. One advantage of a laparoscopy is that, if it is possible, corrective surgery can be carried out there and then.

Endometriosis:

50% of the laparoscopies that we carry out find some level of endometriosis (link to endometriosis). Surgery for endometriosis consists of eliminating as far as possible the loci of endometriosis, endometriomas and the adhesions which occasionally form. In recurring cases where surgery has already been performed, especially when the endometriomas have been removed, it is recommended that no further interventions be carried due to the risk that this poses to the ovarian reserve.

Miomas:

The majority of uterine fibroids (myomas) can be removed using laparoscopy; however, some require open surgery. As there remains a scar in the area from which the fibroid was removed, subsequent pregnancies must be delivered by cesarean.

Adhesions:

Adhesions are bands of scar tissue that are produced in the abdomen as a result of a prior inflammation. For example, an acute perforated appendicitis, pelvic inflammatory infections (generally sexually transmitted diseases, endometriosis and prior surgeries. These adhesions can cause problems for the reproductive organs, making conception difficult. Corrective surgery consists of removing, as far as is possible, these adhesions and rebuilding the pelvic architecture.

Endometrial polyps:

Can be removed using hysteroscopy. This is a technique whereby a small endoscope is introduced into the uterine cavity (endometrium) in order to diagnose and if required, operate from within the uterus. On top of removing the polyps, adherences can be taken out and septa removed that might appear in the same place.

Hydrosalpinx:

As previously mentioned, a hydrosalpinx can mean that inflammatory liquids reach the endometrium and cause chronic inflammation. During a laparoscopy, the affected tube can be removed (salpingectomy), tied and drained (fimbrioplasty).

Uterine anomalies:

Some uterine anomalies can be treated through surgery. Uterine septa, for example, can be removed through hysteroscopy or open surgery. Not all anomalies are correctable with surgery.

Sterilization reversal:

The reversal of the ligation of the Fallopian tubes (Pomeroy technique) in women and the vasectomy in men can be carried out using microsurgery, that is, under the magnification provided by an operating microscope. Results, in the case of women, very much depend on the type of operation and the current age of the patient and in men it depends on the how long ago the vasectomy was carried out (it is better if the reversal is carried out within 10 years of the operation). In vitro fertilization might be a better option in these cases.