Laparoscopy for infertility
Laparoscopy is a surgical procedure that allows a fertility doctor to see inside of the abdomen. In a female, the uterus, fallopian tubes and ovaries are located in the pelvis which is at the very bottom of the abdomen. Laparoscopy allows the fertility doctor to see abnormalities that might interfere with a woman’s ability to conceive a pregnancy. The most common problems are endometriosis , pelvic adhesions , ovarian cysts and uterine fibroids .
What is a laparoscope?
A laparoscope is a thin fiber optic telescope that is inserted into the abdomen usually through the belly button. The fiber optics allow a light to used to see inside the abdomen. Carbon dioxide (CO2) gas is placed into the abdomen prior to inserting the laparoscope. This lifts the abdominal wall and allows for some separation of the organs inside the abdomen making it easier for the fertility doctor to see the reproductive organs during the surgery.
If abnormalities are found during the laparoscopy, additional instruments can be placed into the abdomen through tiny incisions. The incisions are usually made at the pubic hair line on the left and/or right side. Together with the laparoscope in the belly button, this forms a triangle that allows the fertility doctor to perform virtually any surgical procedure that can be performed by using a more traditional “open” surgery where a large incision is made.
Laparoscopy is performed using general anesthesia. This means that the patient is completely asleep during the entire procedure.
What are the advantages of laparoscopy for infertility?
Laparoscopy will allow the diagnosis of infertility problems that would otherwise be missed. For example, a woman who has severe endometriosis can be identified by using ultrasound. A woman with mild endometriosis can only be identified using surgery such as laparoscopy.
Another problem that can only be identified through surgery are pelvic adhesions. Also known as scar tissue, adhesions cannot be seen with ultrasound, x-rays or CT scans. Adhesions can interfere with the ability to conceive if they make it more difficult for the egg to get into the fallopian tube at the time of ovulation.
Many people view laparoscopy as a less invasive surgery that traditional surgery. Traditional surgery requires making an incision in the abdomen which is several centimeters long. This in turn means that the patient has to spend two to three nights in the hospital. Laparoscopy utilizes one to three smaller incisions. Each incision may be one half a centimeter to a full centimeter in length. Most often, patients who have had a laparoscopy will be able to go home the same day as the surgery. In other words, a hospital stay is not usually required.
Some people believed that laparoscopy would result in less adhesions being formed after reproductive surgery. However, this does not appear to be true.
What are the disadvantages of laparoscopy for infertility?
Laparoscopy requires a different set of skills compared to traditional surgery. In many cases, it can be more challenging to complete a procedure. For example, removing one superficial medium sized fibroid can be accomplished equally well through laparoscopy or traditional surgery. However, a woman that has dozen of fibroids, large and small with some occupying the deep layers of the uterus is much better served with a traditional surgery. A good fertility doctor will know when laparoscopy is an advantage and when it is a liability.
Which infertile patients should have laparoscopy?
Generally, laparoscopy should be reserved for couples who have already completed a more basic infertility evaluation including assessing for ovulation, ovarian reserve , ultrasound and hysterosalpingogram for the female and semen analysis for the male. Some couples may elect to skip laparoscopy in favor of proceeding to other fertility treatments such as superovulation with fertility medications combined with intrauterine insemination or in vitro fertilization .
There may be instances in which the fertility doctor may have a high suspicion for finding problems with laparoscopy. for instance, if a woman had a history of a severe pelvic infection or a ruptured appendix, this would increase the likelihood that she may have pelvic adhesions and therefore more likely to benefit from laparoscopy.
Laparoscopy versus IVF
Two commonly encountered problems during a laparoscopy, pelvic adhesions and endometriosis, can also be effectively treated using IVF. Since IVF is less invasive than laparoscopy and has a very high success rate, some couples will opt to skip laparoscopy and proceed directly to IVF. Even if a woman has severe adhesions that are not treated, this would not impact on her ability to conceive a pregnancy with IVF.
Risks of laparoscopy
For the most part, the risks associated with laparoscopy are of the same type that occur with traditional surgery. Problems from anesthesia, bleeding and infections can occur with either type of surgery. The risk of damage to internal organs is also possible with either type of surgery.
What to expect after laparoscopy
The incisions will be covered with bandages that can be removed after twenty four hours. The fertility doctor will give prescriptions for postoperative pain and for nausea. The pain medicine will almost always be needed, the nausea medicine may or may not be needed.
The length of time needed for recovery will depend on the type of procedure that was done, the length of time the surgery took, the number of incisions that were made, whether the patient has had surgery previously, the state of health the patient was in before the surgery, whether any complications occurred and what the tolerance of the patient is naturally.
The patient can eat or drink whatever she feels up to having after an uncomplicated laparoscopy for infertility problems. Due to the anesthesia, she should rest for twenty four hours. Generally thereafter, she may resume normal activities as soon as she feels well enough.
Depending on the type of procedure, some women may be able to return to work in a few days. Other women may require a few weeks.