Fertility Surgery

Minimally invasive techniques are used for a variety of fertility treatments, including:

• Abdominal laparoscopy: This procedure requires only two or three keyhole-sized incisions in the abdomen and pelvic area and is used to diagnose and treat various causes of female infertility, including endometriosis, blocked fallopian tubes and fibroids.
• Intrauterine hysteroscopy: This technique doesn’t require any incisions. Instead, your doctor will dilate your cervix and use a telescopic tool to view the uterine cavity, looking for signs of a uterine septum or polyps, testing the patency (openness) of your fallopian tubes and removing any small fibroids.

Our fertility center specializes in robotic-assisted fertility surgery using the da Vinci® surgical system. This technique offers an alternative to traditional “open” surgeries or laparoscopic surgery to treat many medical conditions, including infertility, using only two or three keyhole-sized incisions. The da Vinci® method allows for super-magnified 3D digital views of the pelvic cavity and enhanced dexterity through robotic arms that the surgeon maneuvers. Conditions that can be treated via a robotic-assisted procedure include:

• Blocked fallopian tubes
• Endometriosis
• Fibroids
• Hydrosalpinges (damaged fallopian tubes)
• Ovarian cysts or endometriomas
• Pelvic adhesions
• Septums and scarring of the uterine cavity
• Uterine polyps

Fibroid tumors can cause pain, a heavy menstrual flow and even infertility, depending on the size and location. If you have fibroid tumors, consider talking with your fertility specialist about a myomectomy.

A myomectomy is a surgical procedure to remove the fibroids and repair your uterus. For women who hope to get pregnant one day, a myomectomy can help relieve your painful or troublesome symptoms and improve your quality of life. Here’s what you can expect:

• First, you’ll have an in-office ultrasound to assess the size, location and number of fibroids present and to plan the appropriate surgical technique to meet your needs best.
• Your myomectomy will involve general anesthesia administered intravenously (through an IV).
• You will not be allowed to drive yourself home after your fertility surgery, so please arrange to have someone responsible for your care and transportation.
• If you require an open abdominal surgery, expect at least an overnight stay in the hospital and four to six weeks of recovery. Most laparoscopic procedures can go home the same day and will recover over two to three weeks.

Though most fibroids are noncancerous, your fertility specialist will order a biopsy to rule out cancer with certainty. Additionally, some women may need to opt for a cesarean delivery rather than vaginal delivery when they get pregnant after a myomectomy.

In extremely rare situations, if your myomectomy is unsuccessful, your surgeon will need to perform a full hysterectomy instead.

You may suspect endometriosis when you encounter symptoms such as a painful or irregular period, but the only way to know for certain is with fertility surgery. Endometriosis occurs when tissue that lines the uterus (the endometrium) migrates and grows outside the uterus. These growths can be found in or on the fallopian tubes, ovaries, bowels, bladder or pelvic region.

Symptoms of endometriosis may include:

• Pain during or after intercourse
• Painful periods and periods with a heavy flow (cramping and lower back pain)
• Pain while urinating or during a bowel movement
• Recurring bloating, nausea or diarrhea

Endometriosis is most often treated with minimally invasive or robotic-assisted surgical techniques rather than traditional open surgery.

If a sonography indicates endometriosis, you have unexplained infertility or symptoms of endometriosis, you will likely benefit from fertility surgery. Your postoperative report will grade endometriosis as mild, moderate or severe. Research shows that treating moderate to severe endometriosis will improve your likelihood of conceiving.

One often undetected cause of female infertility and recurrent miscarriage is a uterine septum. This abnormality, present from birth, essentially divides the uterus in half, hindering a woman’s chances for successful implantation of an embryo and carrying a baby to term.

The membrane dividing the two halves of the uterus is called the septum, and it can vary in length and thickness. Fertility surgery can correct a uterine septum in a large majority of cases by opening the top of the uterus to restore normal shape and function. This procedure is relatively painless, recovery time is short and there is a high success rate in improving pregnancy outcomes after surgery.