Reproductive Surgery

Some women may have difficulty conceiving due to issues related to congenital or acquired problems in their reproductive system. These may range from a congenital malformation of the uterus or absence of a vagina, to acquired abnormalities such as polyps, fibroids or endometriosis. If such a condition is found during our comprehensive fertility evaluation, it may be necessary to have surgery to correct the problem. Some of the surgical procedures available to our patients include:

Hysteroscopy

Hysteroscopy is a procedure in which a small, telescope-like instrument is inserted directly into the uterine cavity. The scope allows the surgeon to visualize the uterine cavity and the ability to diagnose conditions such as uterine septum (protrusion of upper wall of uterus into the cavity), scar tissue, uterine polyps, endometriosis or uterine fibroids. Depending upon the severity of the condition, this procedure can be performed either in our offices or in the operating room. Hysteroscopy allows diagnosis and, most often, resolution of the anatomical problem. This is an outpatient surgery which does not require an overnight stay.

Laparoscopy

Laparoscopy is a non-invasive procedure which allows visualization of the pelvic organs. This is performed in an operating room setting where a small telescope-like instrument is inserted through the belly button. With additional small instruments placed strategically through the abdominal wall, the surgeon is able to view and assess the pelvic anatomy. Some of the findings can include endometriosis, tubal damage - (hydrosalpinx – fluid-filled tube), scar tissue, uterine fibroids, ovarian cysts and tumors. Laparoscopy is an outpatient procedure and often allows the surgeon to correct the pelvic pathology at the same time it is being assessed. Prior to surgery, ultrasound examination will define any potential defects. 

Laparotomy

Laparotomy is a procedure in which an abdominal incision is made for entrance into the abdominal and pelvic cavities. Typically, this procedure requires a longer recovery time since the incision is made through the muscles and the fascia protecting the abdominal and pelvic organs. Sometimes, however, the surgeon is able to perform a mini-laparotomy involving a much smaller incision allowing the patient to leave after a short observation time. This type of surgical procedure gives the surgeon an opportunity to deal with larger sized pelvic pathology such as uterine fibroids, extremely large ovarian cysts, or a ruptured ectopic pregnancy with uncontrolled hemorrhage. Directly accessing the pelvic area allows the surgeon to address most of the very complex issues that may arise. The decision to proceed with a laparotomy will be discussed in detail prior to a planned surgery so that the patient understands the risks and the benefits of the proposed surgery.

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.