Laparoscopy and Infertility

Laparoscopy

A laparoscopy is a surgical procedure, which allows doctors to examine your abdominal organs. In females, their fallopian tubes, uterus, and ovaries are found in the pelvic region, which is at the bottom of the abdomen. The procedure uses a laparoscope to visualize the abdominal organs. This instrument has a long and thin tube with a front camera. The front camera transmits the images captured onto an adjacent screen, which enables your fertility doctor to observe your organs in real time. A laparoscopy can be used as a diagnostic test for the identification of infertility problems.

Why is the procedure used in women with infertility problems?

Various gynecological problems such as fibroid tumors, scar tissues, and endometriosis can be examined through a laparoscopy. Uterine, tubal, and ovarian abnormalities can also be identified using this procedure. Most of these abnormalities usually interfere with a woman’s ability to conceive.

Laparoscopy is widely used since it is a less invasive procedure when compared to an open surgery. You are also likely to get minimal scars after a laparoscopy. In an open surgery, large incisions are made, thereby creating more noticeable scars.

Why is laparoscopy for infertility recommended for you?

Often, your medical records and physical examinations generally do not give a clue about your infertility problems. Therefore, when you visit an infertility clinic, the answers to the underlying cause of your infertility problem will be minimal to none.

In such situations, you are advised to give your pelvis some time and postpone any surgical investigations intended for the pelvis. However, studies from your medical records and examinations may sometimes indicate why an infertility problem is present. Some examples of infertility problems are:

• Continuous and heavy menstrual flow with massively enlarged fibroids in the uterus.
• Painful or uncomfortable sexual intercourse, especially during deep penetration. 
• Painful menstruation. Examinations might reveal an endometriosis, where the tissues lining the uterus grow outside of it.
• Your prior pregnancies are frequently terminated, which signals infertility. When there is a failure to achieve pregnancy, the primary cause might be blocked fallopian tubes due to an infection. 
• When you have a history of pelvic surgery, it might indicate adhesions leading to infertility problems.

Which type of patients should undergo this operation?

In most cases, a laparoscopy is done for partners who have gone through basic infertility examinations, which include the ovarian reserve, ovulation assessment, ultrasound, and hysterosalpingogram (an X-ray of the fallopian tubes and uterus).

How is the surgery performed?

The operation generally takes about two hours of your time, depending on which technique is employed and the corrective work that is required. A complicated case will take up to four hours or even more.

The following are the steps during a laparoscopy:

• Step 1. After administering the general anesthesia, your doctor makes small cuts or incisions below the navel.

• Step 2. The laparoscope (a telescope for viewing abdominal organs) is inserted through the cuts allowing the surgeon to see the areas to be examined.

• Step 3. After identifying the problem, the cuts are stitched back.

Hospital Discharge and Recovery

The patient is usually released from the hospital two hours after completion of the procedure. You will then require an extra two days off from work after a laparoscopic procedure. Mild pain is expected and may last for up to seven days. Pain can be managed by taking pain relievers. You can also get a prescription drug to help relieve nausea. 

The actual length of time to achieve a full recovery will always depend on the type of operation that was carried out, how long the operation took, and the number of cuts or incisions that were made. Your recovery also depends on whether you had a previous surgery, your current health condition, and how tolerant you are toward the surgery.

You are allowed to eat and drink whatever you wish if the laparoscopy operation is successful and without complications. You will need to rest to allow the general anesthesia to wear off. You will likely experience drowsiness from the anesthesia, so a 24-hour rest is highly recommended. Normal activities can then be resumed if you feel well enough. But depending on the procedure performed, it may take weeks for some women to resume their normal activities, while others will only require a few days.

What are some of the complications resulting from a laparoscopy?

The potential risks may include possible injuries to other pelvic organs such as the ureter, bowels, blood vessels, and the bladder. When injuries occur, an open surgery is recommended. However, the risks are generally uncommon.  Anesthesia-related complications can also be experienced. Post-operative infections such as surgical wound infections and bleeding can also occur. 

These risks are generally the same with other types of surgical procedures. However, all of the above complications are unusual when the laparoscopy procedure is done with expertise on healthy women.

Are there any other alternatives aside from a laparoscopy?

1. IVF (In Vitro Fertilization)

The two most commonly encountered risks during a laparoscopy are adhesion and endometriosis. These problems can be treated using in vitro fertilization (IVF). The process of IVF is less invasive when compared to a laparoscopy and its success rates are usually high. Therefore, some couples may prefer the IVF process. If the patient has an adhesion problem, it will not affect her chances of conceiving through IVF.

2. Hysteroscopy

Hysteroscopy is a procedure used to examine the uterine cavity for any adhesions, fibroids, or septum development (a wall that divides the cavity of the uterus)--all of which may hinder a woman's ability to conceive.

3. Pelvic Examination

An internal pelvic examination is carried out to check the cortex and the vagina, and to analyze the size, position, mobility, and the shape of a woman's ovaries and uterus.

4. Surgery

Your doctor might advise you to undergo surgery when there is a blockage in your fallopian tubes, you have a polycystic ovary syndrome (PCOS) that does not respond to drugs, or if you wish to have a reversal procedure. Other surgeries may also be done when fibroids, endometriosis, or any other conditions significantly affect a pregnancy implantation.

Other alternative treatments for infertility can also include fertility treatments such as superovulation and intrauterine insemination. It is highly recommended that you speak with your doctor if you have any concerns about undergoing a laparoscopic procedure.