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Should You Have a Laparoscopy Before IVF?
January 25, 2013
How do you know if laparoscopic surgery is a viable treatment option for your infertility? Patients who have been diagnosed with unexplained infertility, endometriosis, or fibroids, or those who have had a failed IVF cycle might be candidates for corrective reproductive surgery before moving on to more advanced treatments like in vitro fertilization (IVF).
Paul Miller, M.D., of the Fertility Center of the Carolinas in Greenville, South Carolina, says despite the growing trend to move quickly to IVF, many patients can benefit from corrective surgery. “Being a good diagnostician and treating the patient as a whole is important instead of using IVF as the sledgehammer that takes care of anything down the pipe. In about ninety percent of unexplained infertility cases who go on to have a laparoscopy, we’ve discovered a missed diagnosis,” he says.
Dr. Miller says some may consider his approach a little “old school”, but with conditions that diminish endometrial receptivity to embryo implantation, there is obvious need to examine the full package before treating infertility. In addition, Miller says: “We focus on [endometrial receptivity] as a potential impact and can save patients the costs of IVF (especially when many do not have infertility insurance coverage) by using more conventional means of treatment.” He explains that many of his patients have a history of failed IVF cycles or are told IVF is their only option, yet they go on to conceive after being treated with laparoscopy.
However, reproductive surgery will not yield a successful pregnancy in every case. Fertility patients with tubal factor infertility, including blockages and tubal scarring, have shown greater success when moving straight to IVF. Successful conception without assistance after tubal repair is less common, Miller advises.
While it is difficult to quantitatively compare the success of IVF versus the success of reproductive surgery, Dr. Miller says he is confident that reproductive surgery gets patients pregnant. “We’ve looked at the number of patients coming through the door and compared that to the number of obstetric ultrasounds and number of IVF cycles. The number of obstetric ultrasounds and number of people coming in the door has increased, but the number of IVF cycles has remained the same.” His interest is piqued by patients who have been told IVF is their only option for building a family.
For patients who have had a failed IVF cycle despite normal test results, Dr. Miller recommends an evaluation of the endometrium to test for receptivity and a laparoscopy before moving on to another IVF cycle.