Reproductive Surgery

The UCSF Center for Reproductive Health is proud to offer surgical management options for patients.

Conditions which can interfere with reproduction include:

• Fibroids
• Polyps
• Uterine scar tissue (Asherman Syndrome)
• Ovarian cysts
• Endometriosis
• Congenital uterine variants (also called Mullerian anomalies)

Common Surgical Procedures

Whenever possible, our providers offer a minimally invasive approach, to allow faster healing with fewer risks. For very complex cases, we partner closely with UCSF’s Minimally Invasive Gynecologic Surgery (MIGS) division.

Hysteroscopy

Hysteroscopy is an incision-free procedure in which a small camera, or hysteroscope, is placed through the cervix and into the uterus. This allows the doctor to directly see into the uterus to make diagnoses such as polyps, fibroids or scar tissue. Treatment can also be done using small instruments that pass through the hysteroscope in order to restore a normal uterine cavity. This same-day procedure can be done at the CRH office or in the hospital, depending on the situation.

Laparoscopy

Laparoscopy is a minimally invasive procedure in which a small camera, or laparoscope, is placed through the abdomen to directly view the pelvic organs. Additional small instruments can be placed using small incisions to treat issues like endometriosis, injured fallopian tubes (hydrosalpinx), pelvic scar tissue, uterine fibroids, and ovarian cysts. Laparoscopy occurs in the hospital and is an outpatient procedure, where patients generally return home the same day.

Tubal Reversal Surgery

For certain patients who have undergone tubal ligatino, a tubal reversal can be performed to re-establish the reproductive communication between sperm and egg. There are many factors that influence the outcome and determine the appropriateness of this surgery, including the type of tubal ligation that was performed, age, and other infertility factors that may be present. In vitro fertilization (IVF) is an alternative to tubal reversal surgery that patients may consider. 

Vaginal Surgery

Vaginal surgeries are performed for congenital abnormalities in the development of the uterus and/or vagina. These can include longitudinal vaginal septum, transverse vaginal septum, incomplete formation of the cervix or upper vagina, or partial vaginal obstruction (also known as OHVIRA).

Tubal Reversal Surgery 

For certain patients who have undergone tubal ligation, a tubal reversal can be performed to reestablish the reproductive communication between sperm and egg. This type of surgery is most often performed as a mini-laparotomy on an outpatient basis. The surgery involves microscopic reattachment of the cut fallopian tubes together. 

There are many factors that influence the outcome and determine the appropriateness of this surgery. For instance, a tubal ligation that involves fulguration, or “burning” of the fallopian tubes, is not as easily reversed when compared to a tubal ligation in which a clip has been placed on the fallopian tube. 

Prior to surgery, a detailed analysis of the type of tubal ligation previously performed, the likelihood of surgical success, and the best course of action is determined and discussed with the patient. Patients and their partners should complete an infertility evaluation prior to surgery to assure no other infertility factors would compromise outcome.