After an initial assessment your fertility specialist may recommend surgery, either to investigate the cause of infertility or to treat problems that are making it difficult for you to conceive.
Diagnostic laparoscopy and hysteroscopy
For many, this test is an important part of a fertility evaluation but it is usually one of the last tests to be done as it is a more invasive procedure. If your history or other tests show an obvious need for IVF, your fertility specialist may advise deferring or not performing this investigation.
Laparoscopy takes place under general anaesthesia with small incisions made at or just below the navel and the pubic hairline. A laparoscope (a small-diameter telescope) is passed through the incision, enabling your fertility specialist to view the ovaries, Fallopian tubes, uterus and pelvic cavity for abnormalities. Your fertility specialist can check that your tubes are open (tubal patency) by injecting dye through the uterus and observing it spill or not through the ends of the Fallopian tubes.
Hysteroscopy uses another small-diameter telescope called a hysteroscope. This enables your fertility specialist to assess the uterine cavity for abnormalities such as polyps, adhesions or fibroids.
If your fertility specialist suspects that you might have endometriosis, he/she may recommend a laparoscopy to confirm this diagnosis. Treatment depends on the extent of the condition and other symptoms that you may have. It may involve surgical removal of the endometriosis and associated scar tissue at the time of the laparoscopy, or hormone treatment to suppress the menstrual cycle and inhibit the growth of endometriosis.
If treatment for endometriosis does not result in a successful pregnancy, IVF will often be an appropriate option. Your fertility specialist will advise you on the most appropriate combination of treatments.
Several of our fertility specialists have an interest in the treatment of endometriosis, including advanced laparoscopic skills for removing the disease.
If you have any tubal damage or abnormality, this will be diagnosed during the laparoscopy. Some of these conditions may adversely affect your chances of success with IVF unless treated.
Your fertility specialist may recommend tubal surgery before starting IVF treatment in order to improve your chance of natural conception.
If tubal surgery does not result in a successful pregnancy, or where damage to the tubes and other pelvic organs is so severe as to make surgery unlikely to be successful, IVF will be the treatment option with the best chance of success.
Microsurgery may be used for procedures such as the reversal of sterilisation (tubal anastomosis), the re-opening of blocked tubes (salpingostomy) and the removal of scar tissue around the uterus, tubes and ovaries (adhesiolysis).
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 or obstruction in the Fallopian tubes.
Male fertility surgery
As with female surgery, male 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 tubes that carry sperm (the vas deferens).
Microsurgical procedures in men include the reversal of sterilisation (vasovasostomy or vasoepididymostomy) and sperm retrieval procedures.