Surgical Treatment of Infertility

A woman’s pelvic anatomy can be disrupted by various conditions that can interfere with her chances of achieving a successful pregnancy, and in many situations, the condition causing infertility is treatable with surgical options. These women may be labeled with unexplained infertility, when, in fact, surgical treatment could help.

“There are several situations where infertile patients might be better served by more diligent evaluation and treatment of underlying disease,” says Ron Feinberg, M.D., a reproductive endocrinologist with Reproductive Associates of Delaware. “Patients with active endometriosis, polyps, fibroids or even subtle tubal abnormalities may stand a very good chance of conceiving without necessarily needing IVF.”

Diseases Affecting Pregnancy Success

There are several diseases can block embryo implantation and hurt pregnancy chances, including endometriosis, uterine polyps and fibroids, and diseased fallopian tubes. Pelvic adhesions can also restrict blood flow to the ovaries and interfere with normal egg development.

These diseases may also affect a woman’s risk of miscarriage if she does become pregnant. For example, a recent British study found that removing fibroids that distort the shape of a woman’s uterus significantly improved outcomes, with a live birth rate increasing from 23.3 percent to 52 percent.

“Uterine anatomical defects such as fibroids are one of the treatable causes of recurrent miscarriage,” says Laurence Jacobs, M.D., a fertility doctor with Fertility Centers of Illinois in Chicago. “I do hysteroscopic myomectomies for this reason and have much success with them.”

In addition, there are situations in which surgical treatment of endometriosis, polyps and fibroids may increase the chances of success with in vitro fertilization. “Others have published that IVF success can be improved with careful surgical intervention,” Dr. Feinberg explains. “So that has always been our strategy with our patients.”

Surgical Options

Treating conditions that contribute to infertility is often done with minimally invasive laparascopy and hysteroscopy performed in an outpatient setting. However, some surgeries may be performed in a hospital operating room.

Laparoscopy is an outpatient surgical procedure in which your fertility doctor will use a narrow fiber optic telescope inserted through an incision near your navel. Laparoscopic procedures include:

• Tuboplasty — repair of the fallopian tubes
• Ovarian cystectomy — removal of cysts from the ovary
• Treatment of endometriosis
• Myomectomy — removal of fibroids
• Lysis — removal of adhesions

Hysteroscopy is an outpatient procedure in which the fertility doctor will use a narrow fiber optic telescope inserted into your uterus through your cervix to look for and sometimes remove adhesions inside your uterus. Hysteroscopic procedures include:

• Lysis — removal of intrauterine adhesions
• Myomectomy — removal of fibroids
• Correction of congenital abnormalities of the uterus, such as uterine septum

Microsurgery optons include:

• Microsurgical tubal reanastomosis — performed to reconnect the two ends of the fallopian tubes to reverse a tubal ligation
• Myomectomy — removal of fibroids
• Ovarian cystectomy — removal of cysts from the ovary
• Salpingectomy — removal of part of a fallopian tube when a tube has developed a buildup of fluid
• Salpingostomy to create a new opening in the part of the tube closest to the ovary when the end of the fallopian tube is blocked by a buildup of fluid.
• Fimbrioplasty to rebuild the fringed ends of the fallopian tube when part of the tube closest to the ovary is partially blocked or has scar tissue