Reproductive surgery may be able to repair fertility problems that cannot be treated with medication. Reproductive surgery may also eliminate the need for advanced treatments, including in-vitro fertilization (IVF) and other assisted reproductive technology (ART) procedures. Many causes of infertility, including fibroids, cysts, polyps, adhesions, endometriosis, tubal blockage, hydrosalpinx and birth defects, can be treated surgically.
Female reproductive surgery can diagnose and repair conditions that may lead to or cause infertility.
Tubal ligation, in which the fallopian tubes are tied, cauterized, or sealed with a clip or ring, is considered a permanent method of birth control. Sometimes, however, a woman changes her mind about not getting pregnant, and requests tubal reanastomosis (tubal-ligation reversal). Tubal reanastomosis is performed through a small incision, and reattaches the ends of the fallopian tubes with delicate sutures. Women who have had only small portions of their tubes removed, or whose tubes were sealed using clips or rings, are the best candidates for tubal reanastomosis.
Hysteroscopy enables the physician to view, and often correct, problems in the uterus. During hysteroscopy, the cervix is gently dilated, and then expanded with either gas or fluid. A hysteroscope, which is a thin, flexible tube with a camera and light, is inserted through the vagina and into the uterus. Hysteroscopy is also used to repair or remove polyps, uterine fibroids and intrauterine adhesions.
Laparotomy is performed when endometriosis may be causing infertility. It requires a fairly large incision, which allows the physician to better see any abnormalities, but extends recovery time. Laparotomy may be appropriate for tubal reversal and repair, and fibroid removal.
Tubal cannulation is performed to correct cornual occlusion, which is a blockage in a fallopian tube. Using fluoroscopy or hysteroscopy, a thin wire is inserted through the cervix and uterus to open the tube and clear the blockage.
Neosalpingostomy is a laparoscopic procedure that treats hydrosalpinx, a condition in which a fallopian tube is blocked and filled with fluid. Neosalpingostomy folds back the blocked end of the tube. The success of neosalpingostomy depends on the amount of tubal damage and number of adnexal masses (cysts).
Considerations Of Reproductive Surgery
Some conditions may be corrected during a laparoscopic diagnostic procedure, which may heal faster and be less costly than conventional surgery. Treatment options should be discussed with the physician before deciding on a particular procedure, as should the physician’s expertise in the microsurgical techniques often required for reproductive surgery.