Fertility Enhancing Surgery: A Boon for Couples with Infertility!
To have a child, and to extend the family with children is considered a natural progression for married couples. They expect to conceive naturally when the time is right. However, many couples face struggle and get disappointed when they find out that they are unable to conceive naturally. Infertility can have severe impacts on self-esteem, may cause social stigma, marital discord, and may even lead to depression.
While many couples seek early help, others are delayed due to inhibitions and lack of awareness. They approach a fertility centre only when the pressure to have a child gets out of their hand. If you know someone who face difficulties in conceiving after over a year of trying, it might be time for them to consult a fertility specialist and seek professional help. Moreover, if the woman is over 35, the evaluation should begin after the first six months of failed trying.
Medical Advancements to Improve Fertility
Over the past decade, there have been significant advancements in the diagnosis and treatment of reproductive disorders. This has resulted in successful treatment of approximately 80% of infertility cases. Advanced procedures like Hysteroscopy and Laparoscopy help to tackle various issues that hamper fertility. They play a key role in the diagnosis and treatment of infertility today, and hence called Fertility Enhancing Surgeries.
Everything You Need to Know About Gynaecological Laparoscopy
Laparoscopy is a type of surgical procedure carried out to assess the abdominal and pelvic organs without making large incisions in the abdomen. It is called key-holeSince the incision is very small, it is also called key-hole surgery or minimally invasive surgery (MIS). A small incision of 0.5 cm to 1 cm is made at, or just above the navel. Through this incision a long tube called telescope is passed into the abdomen. This telescope is attached to a camera and a monitor. With the help of this system, the internal organs are visualized. Among infertile couples, Laparoscopy is performed in cases of unexplained fertility, disorders of uterus, ovaries or fallopian tube. The same can be followed for conditions such as Adenomyosis, Endometriosis, Fibroids, PCOS, Endometrial Polyps and others.
Unexplained Infertility
Approximately 30% of all infertility is due to female factors, and another 30% results from the male partner. Sometimes infertility issues stem from both partners and neither is at fault. Couples unable to conceive are initially advised to take standard tests like semen analysis, assessment of egg release, imaging test for patency of the fallopian tube, ultrasound or MRI to evaluate reproductive organs. In 15-30% of cases, infertility remains unexplained even after thorough evaluation of the couple.
In such cases of unexplained infertility, laparoscopy is advised. It provides the added advantage of clear and direct visualization of the uterus, ovaries, fallopian tubes, and other pelvic organs. Other underlying conditions such as pelvic adhesion, or surface endometriosis can also be diagnosed and rectified through laparoscopy. It helps to reduce pelvic pain and to improve the functioning of the fallopian tubes, thereby increasing the possibility of conceiving.
Endometriosis
Endometriosis is a disorder in which tissues similar to that of the tissue that forms the lining of the uterus, grows outside the uterine cavity. Inflammation caused by endometriosis can have adverse impact on the sperm or egg, or can block or interfere with their movement through the uterus and the fallopian tubes. In severe cases, the fallopian tubes maybe blocked by adhesions or scar tissue. Laparoscopic resection or ablation of these endometrial implants and removal of adhesion tissue enhances the possibility of conceiving. Operative laparoscopy is performed in the event of ultrasound detections of uterine caused disorders such as fibroids, or adenomyosis and ovarian disorders like PCOS, or endometriosis and fallopian tube disorders like hydrosalpinx, or tubal blockage.
Fibroids
Fibroids are non-cancerous growths which are typically detected during the routine ultrasound preformed for infertility assessment. Although approximately 75% of fibroids are asymptomatic, they can cause menstrual abnormalities (excessive and irregular bleeding), repeated abortions, periods pain/pelvic pain, infertility, constipation and retention of urine. In determining infertility, the location of the fibroid can have an important role to play. For instance, fibroids that present close to the tubal opening can cause tubal obstruction. Intramural fibroids are fibroids present in the uterine musculature, while those are present in the uterine cavity are called submucosal fibroids.
Subserosal fibroids that present on the outer surface of the uterus can cause distortion and enlargement of the uterine cavity, thereby impacting implantation and the growth of the embryo. Implantation failure happens when the fibroids disturb the blood supply and cause inflammation in the endometrium. Fibroids can also cause irregular uterine contraction and interfere with sperm and ovum transport. The size of the fibroid can also represent another important prognostic factor. As no long-term medical treatment has been reported for fibroids, myomectomy is recommended for fibroids which are greater than 5cm in diameter.
Fibroids are removed through the surgical method called myomectomy. Based on the location and the size of the fibroid, laparoscope or hysteroscope surgery is performed. While submucosal fibroids require hysteroscopic approach for myomectomy, intramural and subserosal fibroids require laparoscopic approach. Myomectomy helps preserve the uterus and its reproductive potential and approximately 50% of women with infertility and fibroids become pregnant after myomectomy.
Adenomyosis
Adenomyosis: The lining of the uterus, or endometrium, sometimes grows into the muscle layer of the uterus. This condition is called adenomyosis. It causes Dysmenorrhea (painful periods) and infertility. The sperm meets the egg in the fallopian tube aided by uterine and fallopian tube contractions. In adenomyosis, a disruption arises that prevents these good contractions. Further, during embryo implantation, adenomyosis causes increased irregular contraction in the uterus making it unfavourable for the embryo to implant. The surgical removal of Adenomyosis through Laparoscopic approach is called Adeno-Myomectomy. The procedure helps to improve fertility outcomes.
Endometriosis
Endometriosis affects one in ten women during their reproductive years and commonly manifests with lower abdominal pain on various occasions including before/during/after menstruation, during ovulation, on bowel movement, during urination, and during or after sexual intercourse. Other symptoms include diarrhoea, constipation, abdominal bloating during menstruation and heavy or irregular bleeding on periods.
Endometriosis causes adhesions in the pelvic cavity which disturb the functioning of the fallopian tube and disrupt the transportation of the egg and sperm. It also alters hormonal functions, thereby affecting embryo implantation. Medical therapy alone is not effective in the long-term management of Endometriomas which are larger than 4cm in diameter. Laparoscopic Endometriotic Cystectomy is a surgical procedure done to remove adhesions due to Endometriosis, thereby enhancing fertility.
PCOS
PCOS (Polycystic Ovarian Syndrome) is characterized by chronic anovulation (no release of egg/ovulation) and Hyperandrogenism. Although fertility medications help in the release of eggs and increase the chances of pregnancy, they may not work for all women. Ovarian drilling is a surgical procedure done through laparoscopy, which is recommended for women who have no positive outcome post medication.
Other Gynaecological Laparoscopic Procedures
Fallopian Tube Recanalization: Tubal Sterilization is a popular method for permanent birth control. For women who want to reverse tubal sterilization and restore their fertility, Tubal Recanalization is performed laparoscopically.
Hydrosalpinx
Hydrosalpinx: occurs when secretions/fluid is collected in one or both fallopian tubes. When the far-end of the tube gets blocked, the secretion from the fallopian tube gets accumulated causing it to distend and enlarge. The uterus-end of the fallopian tube remains open, causing intermittent discharge of fluids into the uterine cavity. These fluids can be toxic to the embryo and can mechanically flush or sweep it away. This in turn prevent implantation and leads to infertility. To improve fertility, Salpingectomy is done. This involves the complete removal of the tube(s). Further tubal detachment is performed to disconnect the tube from the uterus.
Hysteroscopy
Hysteroscopy: Hysteroscopy is recommended for diagnostic or operative purposes and often done in a single sitting. This ensures that when hysteroscopy is prescribed for diagnostics it can be easily converted into operative hysteroscopy in the same sitting, if the need for surgery arises. The procedure allows doctors to look inside the uterine cavity using a hysteroscope (a thin long tube attached with a camera), which is passed into the uterus through the vagina. The camera is connected to a TV screen or monitor. A distension media (liquid or gas) is used to distend the uterine cavity and provide space and vision for the surgery. The instruments are passed through the hysteroscope and the surgical procedures are performed through it. Hysteroscopic surgery is performed for numerous infertility conditions such as endometrial polyps, submucosal fibroids, Asherman’s Syndrome, etc.
Endometrial Polyps
Endometrial Polyps involve overgrowth of cell lining in the endometrium. Although mostly asymptomatic, it can cause intermenstrual bleeding and prolonged bleeding during periods. Hysteroscopic removal of endometrial/uterine polyps is recommended.
Submucosal Fibroids
Submucosal Fibroids are removed through Hysteroscopic Myomectomy to enhance fertility rates and prevent repeated miscarriages and preterm labour.
Asherman’s Syndrome
Asherman’s Syndrome or Uterine Synechiae are adhesions formed inside the uterine cavity which lead to decreased flow during periods and absence of periods. This also causes infertility as the adhesions prevent healthy endometrium from being formed, and by hampering the implantation of embryos. Hysteroscopy helps locate and remove adhesions.
Division of Intrauterine Septum
Division of Intrauterine Septum is a congenital anomaly where the uterine cavity is divided longitudinally by a septum (extra wedge of tissue). This can cause infertility, miscarriage, preterm labour, and malpresentation of foetus during pregnancy. Uterine septum can be resected with hysteroscopy.
Fallopian Tube Cannulation
Fallopian Tube Cannulation: Any blocks in the proximal part of fallopian tube near the uterine cavity can hamper the transportation of sperm and can lead to infertility. This blockage can be removed by a procedure called fallopian tube cannulation which requires both hysteroscopy and laparoscopy.
Increased Safety and Efficiency
The success of any infertility enhancing surgery depends on the expertise of the surgeon and the advanced instruments used. Rapid technological advances and higher-quality imaging have allowed surgeons to treat extensive and complicated diseases through laparoscopic procedures with least complications. Newly developed vessel sealing devices driven by bipolar diathermy and ultrasonic technology, decreases operative time, reduces post-operative pain, and ensures faster recovery. As these procedures can be complicated, patients need to consult with doctors who can explain the process comprehensively while offering dedicated care.
Hegde Fertility is the Best IVF Center in Hyderabad, where cost-effective male infertility treatment is done under the supervision of the best Gynaecologist. Contact us to make an appointment.
