Some causes of fertility problems (e.g. endometriosis, polycystic ovary syndrome) can be diagnosed and/or treated via special surgical techniques. Where suitable, surgery may help women avoid the need for assisted reproductive treatments (ART) or in vitro fertilisation (IVF) – or improve pregnancy outcomes from these procedures. Further, if a younger woman has a well-defined, physical cause of infertility, surgery may resolve her fertility issues entirely for years to come (allowing multiple natural pregnancies).
Common surgical procedures which may be used to diagnose and treat fertility issues include:
A hysteroscopy is a procedure used to examine the inner lining of the uterus (womb). It involves a long telescope (hysteroscope) with a light and camera on the end. The hysteroscope passes through the cervix into the uterus, allowing the surgeon to see inside the uterus without having to make any cuts or incisions. If any abnormal tissue is seen by the surgeon during this procedure, he/she will typically try to remove it (preventing the need for a second operation).
Dilatation and curettage (D&C)
A D&C is one way that a surgeon can remove abnormal uterine tissue such as polyps or endometrial hyperplasia (benign thickening of the uterine wall). During this procedure – which may be performed as part of a hysteroscopy – a small instrument is used to first dilate (i.e. open) the cervix. Next, a surgical instrument called a curette is passed through the opened cervix into the uterus, allowing the surgeon to remove abnormal tissue.
A laparoscopy is similar to a hysteroscopy, in that both procedures are initially diagnostic and use a thin telescope-like instrument to examine the uterus. However, a laparoscopy examines the outside of the uterus and surrounding abdominal structures – therefore, it requires a small incision within the belly button. A second incision near the bikini line is also made to allow the use of other surgical instruments. A laparoscope allows the surgeon to identify and remove any abnormal growths on the outside of the uterus or within the abdominal cavity (such as fibroids, cysts or endometriomas) that may be affecting your fertility. Tubal flushing may also be performed during a laparoscopy (see below).
The fallopian tubes are where the sperm meets and fertilises an egg. The resulting embryo can then implant and grow in the uterus. However, if the fallopian tube is blocked, fertilisation and/or implantation may not be possible. There are many causes of fallopian tube blockage, including:
- STI infection (chlamydia or gonorrhoea)
- Pelvic inflammatory disease
- Scar tissue
- Endometrial growths
- Previous abdominal surgery
Tubal flushing aims to clear out any blockages by gently flushing the tubes with liquid – typically water or lipiodol (poppy seed oil). This helps to optimise the health of the fallopian tubes, improving the chances of future successful fertilisation.
Ovarian drilling is specifically used for cases of polycystic ovary syndrome (PCOS). In PCOS, tissue on the surface of the ovaries produces androgens (male hormones) which can reduce a woman’s fertility. This treatment is exactly what it sounds like – the drilling of small holes into the surface of the ovary. This removes the surface tissue responsible for producing the male hormones, helping to stabilise hormone production. This can restore normal ovulation, increasing the chance of pregnancy.
Surgical correction of anatomical issues (polyps, fibroids, uterine septum)
A uterine septum is the most common anatomical issue affecting fertility. This is a congenital abnormality (i.e. an abnormality present from birth), whereby extra tissue grows within the uterus, splitting it into two. Uterine septa have been linked to both infertility and miscarriage. Surgery can be used to physically remove the septum, resolving infertility. Other anatomical issues that may affect fertility include polyps, fibroids or endometrial growths. As mentioned earlier, these are often removed at the time of a diagnostic hysteroscopy or laparoscopy.
Tubal reconstruction surgery/vasectomy reversal
Tubal ligation and vasectomy are two of the most effective and common forms of contraception in Australia, especially in those with an established family. While these are designed to be permanent, it’s not entirely uncommon for people to change their minds and request the procedure to be reversed. Surgical reversal (the re-joining of the fallopian tubes) is not always possible, as it depends on how the tubes were initially disconnected. When it is possible, couples can expect a 50–80% pregnancy success rate. IVF may be a better option than reversal surgery for some, especially if a couple is over 35 years old or have other factors affecting their fertility. If the couple is younger with high fertility levels, reversal surgery may prove to be the more affordable option.
Wondering if fertility surgery could be right for you?
If you would like a personal assessment of your fertility or advice about ways to optimise your chances of conceiving, you can make an appointment with me by calling my rooms on (03) 9418 8299 or by booking online.