After initial assessment, surgery may be recommended to either investigate the cause of infertility for either partner, or to overcome factors influencing their ability to conceive.
FEMALE FERTILITY SURGERY
Diagnostic laparoscopy and hysteroscopy
This test is an important part of the evaluation of many couples. It is generally reserved for the end of the evaluation process as it is a more invasive procedure.
Laparoscopy is done under general anaesthesia with small incisions made at the umbilicus and the pubic hairline. A laparoscope (a fibreoptic telescope) is passed through the umbilical incision and the ovaries, fallopian tubes, uterus and pelvic cavity can be viewed for abnormalities. Tubal patency can be checked by injecting dye through the uterus and observing it spill through the fimbriated ends of the fallopian tubes.
Hysteroscopy may also be performed, using another fibreoptic device called a hysteroscope. It provides direct visualisation of the uterine cavity for growths, adhesions and abnormal anatomy. Laparoscopy maybe omitted in couples where the need for IVF is obvious from the history or analysis of test results.
Endometriosis
Endometriosis is a condition in which endometrial cells (those lining the uterus) grow in places outside the uterus. It may cause symptoms such as painful periods, pain with intercourse, premenstrual spotting and/or infertility.
Should your fertility specialist suspect you to have endometriosis, a laparoscopy may be recommended to confirm this diagnosis. Treatment depends, in part, on the extent of the disease, and may involve surgical removal of the endometriosis and associated scar tissue at the time of laparoscopy, or hormone treatment to suppress the menstrual cycle and inhibit the growth of endometriosis.
Where treatment for endometriosis has not resulted in successful pregnancy, IVF may be an appropriate treatment option.
Several of our fertility specialists have an interest in the treatment of endometriosis including advanced laparoscopic skills for the excision of the disease.
The Endometriosis Clinic at the the Women's Hospital provides medical and para-medical care to women with Endometriosis. Services available include:
- gynaecologists with experience in the medical and surgical management of endometriosis
- counsellors with considerable experience in dealing with the complex issues often facing women with endometriosis (and infertility)
- a nurse practitioner who specialises in pain management, including alternative and complementary therapies
- an exercise and a dance therapist
For appointments in the clinic which is part of the Reproductive Services Department at the Women's, please telephone (03) 8345 3200 or fax (03) 8345 3260.
Tubal Surgery
The diagnosis of tubal damage will usually have been made at laparoscopy.
The presence of tubal pathology may reduce the success rate with IVF treatment and your doctor may recommend you have it treated prior to starting treatment.
In some cases, surgery to remove scar tissue (adhesiolysis) or to correct tubal damage (eg tubal anastomosis) will be recommended. Some types of tubal surgery may be performed through the laparoscope (adhesiolysis, salpingolysis), while other procedures (such as tubal anastomosis) may require an "open" operation using the operating microscope, known as microsurgery.
Where surgery has not resulted in successful pregnancy, or where damage to the tubes and other pelvic organs has been so severe as to make surgery unlikely to be successful, IVF becomes the treatment option with the best chance of success.
Microsurgery
Microsurgical procedures may be used in circumstances such as tubal anastomosis (reversal of sterilization), salpingostomy (the re-opening of blocked tubes) and adhesiolysis (the removal of scar tissue around the uterus, tubes and ovaries).
Microsurgery involves specialised operative techniques including the use of an operating microscope. Surgeons trained in microsurgery use these skills and techniques for the repair of very small structures such as the Fallopian tube.
MALE FERTILITY SURGERY
Microsurgery
Microsurgery involves specialised operative techniques including the use of an operating microscope. Surgeons trained in microsurgery use these skills and techniques for the repair of very small structures such as the vas deferens.
Microsurgical procedures in the male include reversal of sterilisation (vasovasostomy) and sperm retrieval procedures.