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DIAGNOSTIC LAPAROSCOPY INFERTILITY


Laparoscopy for Surgical Infertility Testing and Treatment

Laparoscopy may be used to diagnosis infertility or to treat a fertility problem. Laparoscopy is a surgical procedure that involves making one, two, or three very small cuts in the abdomen, through which the doctor inserts a laparoscope and specialized surgical instruments. A laparoscope is a thin, fiber-optic tube, fitted with a light and camera. Laparoscopy allows your doctor to see the abdominal organs and sometimes make repairs, without making a larger incision that can require a longer recovery time and hospital stay. Whether or not diagnostic laparoscopy should be done in women with infertility is controversial. If a woman is experiencing pelvic pain, then the consensus is that surgery may be recommended. However, in cases of unexplained infertility, or situations where pelvic pain is not a factor, whether the benefits of the surgery outweigh the risks is a matter of debate.

When Is Laparoscopy Recommended?

Your doctor may suggest laparoscopic surgery to help diagnosis a cause for infertility. Usually, it's performed only after other infertility testing has been completed, or if symptoms warrant testing. Laparoscopy should not be done routinely, however. Possible reasons your doctor may recommend diagnostic laparoscopy include:

  • You experience pain during sexual intercourse
  • You have severe menstrual cramps or pelvic pain at other times in your cycle
  • Moderate to severe endometriosis is suspected
  • Pelvic inflammatory disease or severe pelvic adhesions are suspected
  • Your doctor suspects an ectopic pregnancy (which can be life threatening if left untreated)

Often (but not always), if a diagnostic laparoscopy finds problems, the reproductive surgeon will repair, remove, or otherwise treat the issue right away. Laparoscopic surgery may be used to surgically treat some causes of female infertility.
Your doctor may recommend surgery if :

  • Hydrosalpinx is suspected. This is a specific kind of blocked fallopian tube. Removing the affected tube can improve IVF success rates.
  • Endometrial deposits are suspected of reducing your fertility. This is rather controversial, with some doctors saying removal is only warranted if you’re in pain, and others saying it can improve pregnancy success rates and is worth doing even if pelvic pain isn’t a problem.
  • Surgery may be able to unblock or repair a fallopian tube. Success rates vary greatly when it comes to tubal repair. If IVF is going to be required even after surgery, then going straight to IVF is a better choice. If the woman is young and all other fertility factors look good, surgical repair may be worth trying first
  • An ovarian cyst is suspected of causing pain or blocking the fallopian tubes. Sometimes, drainage of the cyst with an ultrasound-guided needle is better. Removal of a large endometrial ovarian cyst may reduce your ovarian reserves. Your doctor should discuss this with you.
  • A fibroid is causing pain, distorting the uterine cavity, or blocking your fallopian tubes.
  • You have PCOS and your doctor recommends ovarian drilling. Laparoscopic ovarian drilling involves making three to eight tiny punctures into the ovaries. In women with PCOS who have not ovulated on fertility drugs, this procedure may enable them to ovulate on their own. However, the risks may not outweigh the benefits, and its use is controversial.
Why Is It Important?

Some causes of infertility can only be diagnosed through laparoscopy. (Endometriosis, for example.) Laparoscopy allows your doctor to not only see what's inside your abdomen but also biopsy suspicious growths or cysts. Also, laparoscopic surgery can treat some causes of infertility, allowing you a better chance at getting pregnant either naturally or with fertility treatments. However, the most important reason for diagnostic laparoscopy is if you’re experiencing pelvic pain. Laparoscopy can be used to remove scar tissue, a fibroid, or endometrial deposits that are causing pain.

  • How Do I Know if My Cramps Are Abnormal?
  • Can Menstrual Cramps Make It Harder to Get Pregnant?
How Is It Done?

Laparoscopy is performed in a hospital under general anesthesia. While it is sometimes possible to conduct a diagnostic laparoscopy in a fertility clinic office, this is not recommended. In the office setting, if something is found during the procedure, you will need to have the procedure again in a hospital setting for the repair. Your doctor will give you instructions on how to prepare for surgery beforehand. You will probably be told not to eat or drink for 8 or more hours before your scheduled surgery, and you may be instructed to take antibiotics. When you get to the hospital, you'll receive an IV, through which fluids and medication to help you relax will be delivered. The anesthesiologist will place a mask over your face, and after breathing a sweet smelling gas for a few minutes, you'll fall asleep. Once the anesthesia has taken effect, the doctor will make a small cut around your belly button. Through this cut, a needle will be used to fill your abdomen with carbon dioxide gas. This provides room for your doctor to see the organs and move the surgical instruments. Once your abdomen is filled with gas, the surgeon will then place the laparoscope through the cut to look around at your pelvic organs. The surgeon may also biopsy tissue for testing. Sometimes two or three more small cuts are made so that other thin surgical instruments can be used to make repairs or move the organs around for a better view. The surgeon will visually evaluate the pelvic organs and the surrounding abdominal organs. He or she will look for the presence of cysts, fibroids, scar tissue or adhesions, and endometrial growths. He or she will also look at the shape, color, and size of the reproductive organs. A dye may be injected through the cervix, so the surgeon can evaluate if the fallopian tubes are open. Even if no signs of endometriosis or other problems are found, the surgeon may remove a sample of tissue to be tested. Sometimes, very mild endometriosis is microscopic and cannot be seen by the naked eye with the laparoscopic camera. If ectopic pregnancy is suspected, the surgeon will evaluate the fallopian tubes for an abnormal pregnancy.