Surgical Fertility Treatment

What is Hysteroscopy?

Hysteroscopy is the procedure in which inspection of the uterine cavity is done with the help of hysteroscope, with access through the cervix, to know the intrauterine pathology. Hysteroscopy allows direct visualization of the uterocervical canal and endometrial assessment.

Indications for hysteroscopy would be, patients with the history of recurrent IVF failures, any abnormality seen on HSG or TVS, any history of previous instrumental intervention or uterine scarring and even history of recurrent miscarriages.

Hysteroscopy is a very vital investigational tool for infertility. Hysteroscopic correction of uterine anomalies and lesions is the best way to maintain normal uterine anatomy and function, thereby restoring fertility.

  1. Endometrial Abnormalities: It includes polypoid endometrium, pale /edematous endometrium, atrophic endometrium, endometritis.  Any atypical appearance on TVS should be followed up with hysteroscopy to rule out such abnormalities.
  2. Endometritis: Hysteroscopic diagnosis of endometritis is highly specific. Appropriate hormonal or antimicrobial treatment following the hysteroscopic diagnosis of endometritis has been shown to improve clinical pregnancy rates following natural or assisted conception.
  3. Endometrial Polyps: It represents the most common intracavitary findings in the infertile patients. Polyp removal appeared to improve fertility and increase pregnancy rates in previous infertile women with no other reason to explain their infertility.
  4. Intrauterine Adhesions: Asherman’s Syndrome, besides causing recurrent pregnancy loss & infertility can also cause amenorrhea if severe. Hysteroscopy is the gold standard of management because along with the diagnosis it can offer treatment.

Hysteroscopy, therefore, should be an integral part of the pretreatment evaluation of infertile women with or without a history of previous treatment failures to avoid unnecessary and expensive repeated treatments.

What is Laparoscopy?

Laparoscopy is a minimally invasive surgery in which small cuts are made in the abdomen, through which we insert laparoscope & specialized surgical instruments. With laparoscopy, we can see the organs and can do the needful procedures required without making any large incisions.

In order to make a diagnosis for infertility, after infertility testing has been computed we may suggest laparoscopic surgery.

Surgery may be recommended if

  • Hydrosalpinx is suspected. Cornual Coagulation or Removal of an affected tube can enhance the IVF success rate.
  • Endometriotic deposits sometimes reduce the fertility rate. If the woman is young and all other factors are good, laparoscopic surgical repair is good.
  • Ovarian Cyst can be a cause. Removal of large endometrial ovarian cyst is done before starting fertility treatment.
  • In PCOS, laparoscopic ovarian drilling is beneficial, ovarian drilling may enable them to ovulate on their own.

Laparoscopic surgery can treat some causes of infertility. It can be used to remove scar tissue, fibroid or endometrial deposits that are causing pain.

Laparoscopic surgery is less painful for the body than conventional types of surgery with big incisions. Also patient experience less pain, distress & speedy recovery.

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