Infertility Treatments > Surgical > Laparoscopy

    If the history is suggestive (i.e. prior surgical procedures), if the chlamydia titer is positive (suggestive of prior infection), if the initial exam and ultrasound suggest significant endometriosis, or if the HSG is abnormal, laparoscopy should be the next step.

    Laparoscopy is a minor surgical procedure that is performed under general anesthesia on an outpatient basis. A small instrument resembling a telescope and measuring less than half an inch in diameter is inserted just under the belly button. A small amount of gas is then introduced into the abdominal cavity, allowing complete visualization of the pelvic and abdominal organs. Often this procedure is videotaped to allow the patient to view the findings and procedure at a later date. Recovery in the hospital usually takes an hour or two. After a few days (at most) at home, recovery is usually complete and normal activity may be resumed.

Uses of Laparoscopy

    Laparoscopy is a time-honored means of evaluating the ovaries, tubes and surrounding structures to see if they are normal, and laparoscopy certainly still has its place. It is one of the most valuable tools available to the physician evaluating and treating the subfertile female. But there are extremely rare circumstances under which it should be done simply for diagnostic purposes in evaluating infertility. If a laparoscopy is done, it can be done as a potentially therapeutic procedure by which the physician can treat and correct virtually any pathology or abnormality found.

    One to three, or even four, additional small (5mm) incisions can be made in inconspicuous areas to allow the physician to introduce additional instruments for the purpose of operating and correcting abnormalities. The following surgical procedures can be done by laparoscopy: removal of adhesions, repair of the fallopian tubes, removal of ovarian cysts, treatment of endometriosis (laser, cautery, etc.), removal of ectopic pregnancies, removal of ovaries and/or tubes, appendectomy and hysterectomy.

    The key point about laparoscopy is this: in the hands of an experienced laparoscopic surgeon, virtually any procedure that can be performed by a major surgical procedure (one performed through a major abdominal incision, and requiring a hospital stay and six to eight weeks of recovery) can be accomplished via laparoscopy. And there are significant advantages to a laparoscopic approach: Recovery is quicker and easier, and the results are as good if not better than those obtained by major surgery.

    There's also this consideration. Let's suppose we do a laparoscopy and see that there are adhesions and distal tubal occlusion (the end of the tube by the ovary is blocked), perhaps as a result of a chlamydia infection. There are two options. We can go ahead and remove the adhesions and open the tubes at the time of the laparoscopy or we can see the problem, quit, and come back and do a major surgical procedure to remove the adhesions and open the tubes. In terms of chances of success, the two approaches are essentially equal in the hands of a skilled laparoscopic surgeon. In terms of patient suffering, inconvenience and disability, there is no comparison. In terms of financial liability, there is no question which approach makes better sense. Be sure that you find out what the surgeon performing your laparoscopy intends to accomplish at the time of your laparoscopy.

Uterine Suspension

There is no right or wrong position of the uterus. But many women whose uterus is severely retroverted or retroflexed (very posterior) have pain with intercourse. There is also some evidence that a uterus in this position may be associated with increased pain with periods and difficulty conceiving. There are a couple of procedures that can be performed at the time of laparoscopy to move the uterus to a more anterior, or normal, position. Known as "uterine suspension", we have had tremendous success with these procedures for the relief of pain and for improvement of chances of conception.

© 2005 Jarrett Fertility Group