Surgical Treatment Options at the Southern California Reproductive Center
Surgical infertility treatments for women include the removal of uterine fibroids and the removal of endometriosis tissue. Examples of surgical treatments for men are vasectomy reversal and varicocele repair, a procedure treating varicose veins in the scrotum. If you're unsure whether a surgical or medical infertility treatment is right for you, the fertility specialist physicians of the Southern California Reproductive Center can help determine your best option.
Minimally Invasive Surgery
Infertility Laparoscopy
Hysteroscopy
Transvaginal Hydrolaparoscopy (THL)
Evaluation of the Lining of the Fallopian Tubes
Minimally Invasive Surgery
Infertility can be caused by a variety of problems in the pelvic anatomy. Examples of such problems are birth defects, fibroids, polyps, and pelvic adhesions. Our physicians are highly skilled in the surgical and microsurgical techniques used to correct these conditions, and our surgical facility is fully equipped and staffed for the spectrum of these infertility procedures. Our procedures are conducted with the combined goals of minimal intrusion and restoration of the anatomical conditions necessary for a successful pregnancy.
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Infertility Laparoscopy
Laparoscopy is a surgical procedure that allows the surgeon to visualize and treat anatomic abnormalities by using a very small fiber-optic lens inserted through a small incision in the navel. If necessary, additional small incisions are made to allow the use of other specialized surgical instruments during the procedure. For an infertility laparoscopic procedure, the abdomen is filled with carbon dioxide gas, causing the cavity to expand, giving a clear view of the reproductive organs. Laparoscopy is an excellent modality for evaluating the outside of the uterus and fallopian tubes. The procedure is performed under general anesthesia.
Compared to procedures performed with larger abdominal incisions, laparoscopies typically result in reduced recovery time and increased comfort. Laparoscopic patients typically can return to normal activities after only two to three days of recovery. While laparoscopic techniques continue to be developed and refined and are used in the diagnosis and treatment of an increasing number of medical conditions, the final choice of surgical technique depends on the unique characteristics of each patient's case.
A laparoscopic procedure may be the appropriate choice for the:
- Evaluation of infertility
- Diagnosis and treatment of endometriosis
- Treatment of ovarian cysts
- Removal of uterine fibroids
- Removal of adhesions
Endometriosis or adhesions that may be discovered during the laparoscopy can be treated at the time of the procedure. Laparoscopy is considered the “gold standard” for the detection of tubal disease, and should be considered in any patient with risks factors such as a history of sexually transmitted disease, pelvic inflammatory disease, previous pelvic surgery, or appendectomy.
Many diseases and abnormalities of the abdomen and pelvis can be safely treated using laparoscopy. With special laparoscopic instruments, the surgeon can incise, biopsy, cauterize, or vaporize areas of interest without the need for a large abdominal incision (laparotomy). Postoperative pain and recovery times are significantly lower with laparoscopy compared to traditional open surgery. As with a hysterosalpingogram (HSG), laparoscopy should be done during the early part of the menstrual cycle to avoid disruption of possible early pregnancy.
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Hysteroscopy
Hysteroscopy is a surgical procedure used for looking within the uterine cavity (diagnostic laparoscopy) and performing necessary sampling (biopsies) and corrections (operative laparoscopy). The procedure consists of gently dilating the canal of the cervix, and inserting a narrow viewing instrument (hysteroscope) directly through the canal into the uterine cavity. Hysteroscopy allows for direct and clear visualization of the cavity, and enables treatments of abnormalities such as polyps, fibroids, and projections of the uterine wall.
Transvaginal Hydrolaparoscopy (THL)
Transvaginal hydrolaparoscopy is a minimally invasive procedure that enables visualization of pelvic structures, such as the exterior of the uterus and tubes, without the need for an abdominal incision. The THL procedure consists of making a small incision in the vagina directly behind the cervix. A narrow viewing instrument (endoscope) can be inserted through this incision to enter the pelvis directly behind the uterus. THL offers the benefits of minimal anesthesia requirement, absence of abdominal incisions, and direct visualization of pelvic structures. It can also help determine the need for laparoscopy.
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Evaluation of the Lining of the Fallopian Tubes
Blockages or disease of the interior of the fallopian tubes (the tubal mucosa) can exist even in the setting of an apparently normal HSG. Salpingoscopy and falloposcopy are two techniques that allow visualization of the tubal mucosa.
Salpingoscopy
Salpingoscopy is performed at the time of laparoscopy, and involves the insertion of a viewing instrument called the salpingoscopy through the ends of the tube. This enables a view of the distal portion of the tubal mucosa, and helps to diagnose areas of thinning (denudation) and scarring (adhesions) within the tube.
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Falloposcopy
Falloposcopy is performed in conjunction with hysteroscopic guidance. A thin and flexible microendoscope called the flexible falloposcope is inserted through a tubal opening called the ostium and advanced using a guiding catheter. This technique allows for visualization of the entire length of the fallopian tube. Falloposcopy can provide information on the presence of adhesions, denudation, and blockage (obstruction) along the entire tube. Procedures to correct blockage can also be performed during falloposcopy.
Schedule a Private Consultation with Our Fertility Physicians
Determining whether a surgical or medical treatment is your best option can be accomplished by working with highly experienced fertility physicians like those of the Southern California Reproductive Center. Ovulation induction, laparoscopic surgery, donor insemination, and IUI (artificial insemination) at our Los Angeles-area facilities are some of the options that can help you achieve your dream of conceiving and bearing a child. Schedule a consultation with a Southern California Reproductive Center physician to begin your journey.
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