Not all patients undergoing fertility treatment require surgery. And, the surgeries often performed to treat infertility are varied. Dr Morgan is the area’s leading expert on robotic-assisted surgery for fertility.
The common reasons why surgery is recommended for a woman who has infertility:
History of pelvic infections
Uterine & cervical polyps
Prior pelvic surgeries that could have caused scarring (adhesions)
A couple who has unexplained infertility, which means all their tests have been normal thus far, may be offered a diagnostic laparoscopy to evaluate for endometriosis and pelvic adhesions. This is done under general anesthesia. A small incision is made under the belly button. A small telescope camera is placed through the incision.
Myomas are normally not a cause of infertility unless they are submucosal (this means tumor pushes inside the womb where the baby would grow and would cause heavy bleeding with each menstrual cycle). A hysteroscopic myomectomy can be performed as an outpatient procedure with no incisions, to remove the tumor (if it is not too big). Large myomas may need a larger abdominal incision to remove it (exploratory laparotomy with myomectomy)
Pelvic infections caused by STDs (sexually transmitted diseases such as Chlamydia) can lead to pelvic adhesions and fallopian tube blockage (hydrosalpinx) Some of these blocked tubes can be repaired laparoscopically, however if the tube is severely damaged, it should be removed.
Endometriosis, which is hereditary if the women has a mother or maternal aunt, can cause pelvic pain and infertility. This condition is present in 7% of the reproductive age general population. However, if you have a family history, your changes of having endometriosis increases seven-fold. Endometriosis causes pelvic pain in 50% of patients that have it while the other half have no pain at all. A laparoscopic laser, excision, or burning of these lesions is recommended.
Polyps within the uterine cavity can cause infertility and abnormal uterine bleeding. A pelvic ultrasound with saline can identify these simply. A hysteroscopic removal is performed in the hospital as an outpatient.
Prior pelvic surgeries for appendectomies or intestinal problems can cause adhesions. If someone had an infection after their surgery, this is a red flag that it may have affected the fallopian tubes. A diagnostic laparoscopy is recommended. However, if it was a severe infection, surgery may not be ideal and In Vitro Fertilization (IVF) may be recommended because the fallopian tubes may be damaged beyond repair.