Surgical Procedures

Surgery for myomas (fibroids), polyps, ovarian cysts or growths (e.g., dermoid), endometriosis and adhesions (scar tissue). All conditions which may prevent a pregnancy. These infertility surgeries are described in details below.

Hysteroscopy

Hysteroscopy is considered to be minimally invasive surgery that enables a complete assessment of the uterine cavity. For this surgery, general anesthesia is usually given, although it can be performed with IV sedation, spinal or local anesthesia. No incision is necessary since the procedure is performed by accessing the uterus transvaginally.

First, the cervix is dilated. Next, the hysteroscope (a small telescope camera) is placed inside the uterus. Fluid is used to distend the uterus so that the entire endometrium can be clearly visualized with the hysteroscope.

	Hysteroscopy information handout
	Post-op instructions after Hysteroscopy

Advanced Laparoscopy

Laparoscopy is considered to be minimally invasive surgery that enables a complete assessment ofthe pelvic anatomy. For this surgery, general anesthesia is given. Then, a small (5-10 mm) incision is made in the umbilicus. The abdomen is then filled with carbon dioxide gas in order to better visualize the pelvic anatomy.

Next,the laparoscope (a small telescope camera) is placed inside the abdomen so that the pelvic organs can be clearly visualized. Often times, additional incisions will be made on the left and right sides ofthe lower abdomen above the pubic bone. This is done so that any abnormalities that are identified can be treated during the surgery.

	Laparoscopy handout
	Postoperative instructions after Laparoscopy

Tubal Anastamosis

Women who have previously undergone a tubal ligation may decide later on that they desire to have more children.  Although a tubal ligation is considered to be permanent, some women are candidates for a tubal reversal.  These include women who are still young and have enough fallopian tube attached to the uterus to be able to repair it.  To assess the length of fallopian tubes prior to surgery, I recommend a hysterosalpingogogram (HSG).  This way, prior to scheduling surgery we are able to assess if one or both tubes can be repaired.  Surgery can be done laparoscopically or with a small bikini cut incision.  The fallopian tubes are reattached by suturing them together.  Women usually go home a few hours after surgery if it is performed laparoscopically or after one night in the hospital if it is done as an open procedure.

This surgery may not be successful.  Some women are only able to repair one (not both) fallopian tubes.  Women who have a successful tubal anastamosis are at risk for an ectopic or tubal pregnancy when they conceive.  It is recommended that for each and every subsequent pregnancy, a woman have an early ultrasound exam during the first trimester to ensure that the pregnancy is intrauterine.  For these reasons, some women choose to undergo in vitro fertilization (IVF), rather than surgery, especially if they think that they only want to have one or two more children.