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Surgical Evaluation of Infertility

Female infertility can be caused by multiple factors. Among the most common are ovulation disorders, fallopian tube disease, endometriosis, and uterine defects. While problems with ovulation are managed primarily with medications, the remaining conditions are most commonly diagnosed and treated with surgical intervention. Sonogram imaging of the uterus and ovaries may show conditions such as ovarian cysts or uterine fibroids (benign muscle tumors) that can compromise fertility. Another common component of the fertility evaluation is the “dye test”, or hysterosalpingogram (HSG). This radiologic exam evaluates the uterine cavity and patency of the fallopian tubes. If either of these tests is abnormal, your doctor will likely recommend a surgical procedure for evaluation and treatment of the problem.

The most common surgical treatments include laparoscopy and hysteroscopy. These are both minimally invasive outpatient procedures that involve insertion of a small telescope through either the belly button (laparoscopy) or cervix (hysteroscopy). These telescopes are attached to cameras which are then connected to computer monitors so that the pelvic structures can be easily visualized by the operating room personnel. The vast majority of pelvic and uterine abnormalities can be treated by your doctor with these procedures at the time of diagnosis. Endometriosis (abnormal uterine lining growing on structures outside of the uterus) may be present in the absence of any symptoms such as heavy, painful periods and even when the sonogram or HSG is normal. Laparoscopy is the only reliable method to make the diagnosis of this condition and is also the best way to treat the disease, usually with laser or resection. The recovery time for hysteroscopy is usually 24 hours and for laparoscopy 2 to 3 days before resuming normal activities.

Occasionally, women will have a significant anatomic condition that requires a more invasive surgical approach. The most common problem is large or multiple uterine fibroids that extend deep into the uterine muscle. In this situation, an incision is made in the lower abdomen (“bikini cut”) and the fibroids removed and uterus repaired through this incision. This procedure is called a mini-laparotomy and typically requires an overnight stay in the surgical unit and several weeks of recovery.

For many women, surgical management of infertility will result in the ability to conceive naturally or with minimal intervention. Reproductive endocrinologists receive an average of three years of additional training in these specific procedures compared to general gynecologists and are uniquely qualified to provide these fertility-enhancing treatments.

For more information on the surgical management of infertility please visit http://www.txfertility.com/04surgical-treatment.php or call our office at 512-451-0149.


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