When is surgery needed for infertility treatments?

Fertility surgery means operating on men or women to fix any structural issue resulting in infertility. In women, surgery can fix conditions such as endometriosis, fibroids, polyps, and other problems in the reproductive organs. In men, surgery can correct a varicocele or reverse a vasectomy. The two most common surgical methods are hysteroscopy and laparoscopy.

What is a Hysteroscopy?

In hysteroscopy, a clear look at the lining of the uterus is seen by inserting a small, lighted tube, called a hysteroscope, into the vagina. This method helps find the cause of abnormal bleeding and examine the shape and size of the uterus for problems. In the same method, any uterine growths like small fibroids or polyps are removed, and excessive growth of endometrial lining can be excised and sent for biopsy, septum inside the uterus can be removed.

What is Laparoscopy?

Laparoscopy is a minimally invasive surgery where a small camera and operating instruments are used to see the reproductive organs such as the ovaries, fallopian tubes and uterus. First, a minor incision is made in the abdomen to insert the camera that is used in the surgical procedure. Then the surgeon can rectify infertility caused by viewing the respective organ via the camera.

When is surgery helpful for infertility treatments?

Female infertility issues treated with surgery

After the fertility specialist diagnoses the cause of infertility, they may suggest surgery as a treatment for structural issues in the uterus, fallopian tubes or pelvic area.

Women have a congenital uterine structural issue where the uterus is not formed correctly. These conditions are known as the bicornuate uterus or a septum uterus. In these cases, surgery is the only treatment option to restore fertility.

Endometriosis

When women have endometriosis, the tissue on the inside lining (the endometrium) of the uterus implants in other parts of the abdomen, making pregnancy difficult. Laparoscopic surgery is done to remove as much of the endometrial tissue as possible to increase the chances of pregnancy. 

Fallopian tube blockage

At least a single working Fallopian tube is necessary for successful fertilization. The fallopian tube is where the egg and the sperm meet. Depending on the location and extent of the blockage, the surgical procedure is chosen:-

  • Tubal reanastomosis: Damaged Fallopian tubes are repaired surgically and remove the blocked or diseased portion of the tube. The two healthy ends are connected. This surgery can be done by making an incision in the abdomen or laparoscopically.
  • Salpingectomy: In this procedure, the chances of pregnancy through IVF increase. If there is a build-up of fluid in the tube (hydrosalpinx), that part of the tube is removed.
  • Salpingostomy: This surgery also corrects fluid accumulation in the tubes. But an opening is created in part of the tube closest to the ovary.
  • Fimbrioplasty: Blockages in the fringed ends of the fallopian tube which sweep the released egg are removed. It is done especially when the end of that tube closest to the ovary is partially blocked.
  • Tubal cannulation: Tubal blockages located close to the uterus are removed by inserting a catheter through the vagina to the blocked fallopian tube. After locating the blocked section, the doctor will open the area using a balloon on the catheter.

Uterine fibroids

Uterine fibroids are benign lumps that grow in and the patient experiences cramping, heavy bleeding, painful sex or an urge to urinate. This condition especially causes problems with the fertilized egg attaching to the uterine lining. Various treatments are:- 

Myomectomy 

It is the most preferred method since it removes the fibroids but leaves the healthy tissue in the uterus. 

Uterine polyps

Uterine polyps, also known as endometrial polyps, where there is a cell overgrowth, and attach to the inner wall of the uterus. Uterine polyps lead to infertility since they obstruct the implantation of an embryo or cause a miscarriage. The surgical option is to remove the polyps during a hysteroscopy procedure.

Pelvic adhesions

Pelvic adhesions surrounding the ovary may impair the ability of an egg to reach the tube after ovulation. If the adhesion is in the tube, it prevents the sperm from reaching the egg or an embryo from reaching the uterus. Adhesions occur due to previous surgery. Pelvic adhesions are removed laparoscopically.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a hormonal disorder unlike other conditions described above. It affects ovulation, and the surgical method to treat used PCOS is Laparoscopic ovarian drilling. The ovary parts triggering unintentional ovulation are destroyed using a laser or electrocautery.

Male fertility surgeries

Below are the most common surgical procedures to treat male fertility issues

Vasectomy reversal

This is the most common surgical procedure done in men where the vas deferens, disconnected during the vasectomy, will be reconnected. For this, a small incision is made in the testicle, and the reconnected vas allows sperm to enter the seminal fluid once again.

Varicocelectomy

 Varicocele is the enlargement of the veins in the scrotum that disrupts a man’s fertility. Varicocelectomy surgery removes the enlarged veins and restores normal blood flow to the reproductive organs. Varicocele is not always treated, but surgery may be recommended if it is causing infertility.

Sperm retrieval

If the man’s semen carries no sperm, there may be a structural problem. Along with a urologist, Sperm retrieval techniques can be done using microsurgical epididymis sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).

The retrieved speak is used in IVF, ICSI, or cryopreservation.

Congenital causes where a person is born with the structural abnormality and conditions that alter their reproductive system will require surgery.

At ZIVA fertility center, we have certified and highly qualified reproductive & infertility experts who can educate couples about their options and recommend whether or not surgery will yield desired results. In addition, we are highly skilled in providing both non-surgical and surgical treatments. A clear picture of both pros and cons of each option are explained before landing on the best treatment for each person. Please contact +91 91000 02737 or +91 93474 06900 to consult our fertility specialist. E-mail us at info@zivafertility.com

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