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Can Surgery Help Me to Get Pregnant?
In today’s world of exciting new technologies, the role of surgery in helping our patients get pregnant often takes a back seat. Some fertility doctors have limited the surgeries they do --- and some have eliminated doing surgery altogether!
While I love the practice of in-vitro fertilization (IVF) and the amazing benefits it provides my patients, I still believe that surgery has a vital role. As our field has developed and grown, surgical techniques have also improved, making surgery less invasive and more effective than ever before. Depending on the individual patient and the problem we are facing, surgery can be used both to improve natural fertility and to improve outcomes with fertility treatments.
There are many problems that can be treated effectively with surgery (and this list is not exhaustive!). First, the uterus (womb) can often develop polyps (excess tissue in the lining) or fibroids (benign muscular tumors) that can prevent implantation of a normal embryo. Some women with these growths can get pregnant, but have miscarriages. Women born with a fibrous division of the uterus (septum) will often have repetitive miscarriages --- fixing this can improve outcomes by up to 90%! Secondly, cells of the uterine lining can be found outside the uterus (endometriosis). Such cells can cause scarring, which prevent sperm and egg from meeting, as well as pain and discomfort with periods and during intercourse. Depending on the amount and location of these cells, removing such endometriosis can dramatically improve both natural and assisted reproduction – as well as dramatically improve a woman’s quality of life. Finally, fallopian tubes that are severely damaged from prior infections, surgeries, or abnormal pregnancies can harm embryos and prevent them from implanting. Removing these fallopian tubes is often recommended, as it has been shown to improve pregnancy rates (using IVF) by 20-30%.
While surgery may not be necessary for many of the patients I see, it remains helpful for some patients and critical for others. For some women, I recommend starting fertility treatment, then performing surgery if pregnancy is not achieved. For others, I strongly recommend surgery before moving on to inseminations or IVF. Recommending surgery can often be a downer for patients who want to get pregnant right away. While some operations do require taking a few months off, most are performed using minimally invasive techniques and patients can try to get pregnant the next month!
Being evaluated and treated for surgical problems remains critical to the care of women trying to conceive. As with everything we do, it is important that we get to know each patient and individualize our plan of attack in order to achieve the final goal. In the right patient, surgery can help achieve the goal of bringing home a new baby.