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Why Laparoscopy and Hysteroscopy May Help You Conceive

May 13, 2013

Laparoscopy and hysteroscopy are two minimally invasive surgical procedures used in the diagnosis and treatment of certain female factor infertility conditions. For fertility patients with a suspected diagnosis of endometriosis, fibroids, or polyps, or for those with a history of pelvic infection, laparoscopy and hysteroscopy can be used simultaneously to ascertain the state of the uterine cavity.

George Kofinas, M.D., founder and Medical Director of the Kofinas Fertility Institute, says laparoscopy is extremely important for evaluating the uterine cavity, fallopian tubes and ovaries, and when looking for endometriosis especially in women with no symptoms. “For many women, the first symptom [of a fertility compromising condition like endometriosis or fibroids] is the inability to get pregnant,” he says.

Using hysteroscopy and laparoscopy, a reproductive surgeon can remove scar tissue, clear the fallopian tubes, and remove fibroids, cysts, or lesions. They can also correct congenital abnormalities such as uterine septum or adhesions which can cause miscarriage or premature labor. More complex conditions like large fibroids and tubal ligation reversal can be addressed with laparotomy (an open abdominal surgery) or robotic laparoscopy.

Dr. Kofinas believes that minimally invasive laparoscopy and hysteroscopy can be used as first line diagnostic tools and should be included in the fertility work-up of female patients before pursuing in vitro fertilization (IVF). “Some centers do IVF without fully investigating the couple or what the problem is. There could be scar tissue, endometriosis, or another condition that affects fecundity,” Kofinas states. When it comes to the treatment of endometriosis, there are two schools of thought: removing endometrial scar tissue before beginning fertility treatment or bypassing the scar tissue with IVF. While IVF may successfully bypass scar tissue and allow the patient to conceive, there is a greater risk of miscarriage and implantation issues.

Though these procedures are surgical, the benefit of knowing the condition of the uterine cavity is great.

Recent research has shown that laparoscopy can even uncover a fertility diagnosis like endometriosis in women previously diagnosed with unexplained infertility. In his own experience, Dr. Kofinas has found this to be true in close to 70% of unexplained infertility cases- with or without the presence of scar tissue. “There is no correlation between the amount of endometriosis and the impact it has on fertility. A lot of women either have pelvic pain or bleeding. They might have one or two or all symptoms of endometriosis ranging from mild to severe. The first symptom may be the inability to conceive yet no one thinks of endometriosis if the patient does not have pain,” Kofinas explains.

Laparoscopy and hysteroscopy are beneficial to all patients unless there is an obvious infertility diagnosis, significant male factor infertility with no other evidence of female factor infertility, and treatment of the patient’s infertility will be relatively easy. Many patients who undergo laparoscopy and hysteroscopy go on to conceive spontaneously. Should the results of laparoscopy and hysteroscopy come back normal, Dr. Kofinas re-evaluates the female patient’s egg quality and begins to discuss other reproductive options.

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