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Fertility surgeries  

 Fertility    surgery    also    called as    reproductive   surgery    involves wide range of operations to restore fertility.  In   conditions  where medical line  of  treatment fails , surgery  is   offered .   The main  purpose is to save uterus, tubes  &  ovaries . It could be minimally invasive  or conventional  surgery , can be diagnostic or operative .
Female  surgical  options are  laparoscopy, hysteroscopy, tubal  reanastomosis .
Male surgical options are TESA , PESA , testicular biopsy , vasectomy reversal .
ROLE OF LAPAROSCOPY :
It is a minimally invasive  procedure where abdomen is visualized through a key hole incision under  anaesthesia . It is an integral part of evaluation which allows visualization of adominal  and pelvic organs  and helps in diagnosing  some of the causes  and treat them .
Laparoscopy detects endometriosis , scarring , fallopian tube damage , adhesions , ovarian cysts, fibroids, congenital abnormalities and polycystic ovaries . When the contributing factors are diagnosed , it is called diagnostic laparoscopy. This is performed after all the basic infertility tests are carried out .Very often , these problems are treated when they are diagnosed and that’s called as surgical laparoscopy.
Advantages of laparoscopy over conventional surgery :  it is minimally invasive , shorter  duration of   surgery,  shorter  hospital stay, less postoperative pain & speedy recovery with a minimal  scar.
Role of laparoscopy in endometriosis :
Surgical treatment for endometriosis is usually carried out in one of the following situations :

  1.  mild to moderate endometriosis
  2. If medical treatment has not worked
  3. If there is moderate to severe endometriosis
  4. When endometriosis recurs

The aim of conservative surgery is to return the appearance of the pelvis to as normal as possible. This means destroying any endometriotic deposits,  removing ovarian cysts,   dividing adhesions   and restore the normal pelivic anatomy .
Chromopertubation —  When  laparoscopy is performed for diagnostic or therapeutic   purposes in   women with infertility,  chromopertubation (instillation of dye through the fallopian tubes ) is often  performed   to assess tubal patency. Spillage   of the  dye from  each  tube   is noted as a confirmation of tubal patency.
Other conditions treatable with laparoscopy :

  1. Laparoscopic ovarian drilling : a surgical treatment that triggers ovulation in women with polycystic ovary syndrome (PCOS) .
  2. Removal of Pelvic adhesions ( Adhesiolysis )
  3. Removal of Ovarian cyst ( where only cyst is removed , leaving behind the normal ovary)
  4. Myomectomy( Removal of myoma or fibroid )
  5. Reanastomosis of the tubes

HYSTEROSCOPY :
It is a daytime / outdoor procedure , done with or without anaesthesia to visualize the inside of the uterus .  It can diagnose the cause of   infertility, recurrent pregnancy loss such as    malformations  of uterus , septae , adhesions and correct them simultaneously .
DIAGNOSTIC HYSTEROLAPAROSCOPY ( DHL ) :
Hysterolaparoscopy   is one of the most important tools for investigating the female . Here a thin & slender laparoscope is introduced  in the abdomen  to look into the internal organs ,      to  diagnose the accurate problems , simultaneously  hysteroscope allows   visualization    of interior anatomical problems such as septum, polyps, adhesions etc .
“ Laparoscopy and hysteroscopy allow physicians to diagnose and correct many gynecologic disorders on an outpatient basis . Patient recovery time is brief and significantly less than the recovery time from abdominal surgery through larger incisions .”