Surgeries that can enhance fertility
Fertility enhancing surgeries are usually advised to young women with suspected minimal to moderate disease of tubes, ovaries or uterus. These surgeries may enhance the rate of spontaneous pregnancy or IUI treatment. Usually such surgeries are done by experts through laparoscope to prevent damage to pelvic organs.
Fertility enhancing surgeries in female infertility
Uterine fibroids are the most common tumours in the female. Fibroids in infertile women undergoing assisted reproductive treatment can decrease success rates than do age-matched women with no fibroid. Removal of fibroids(myomectomy) can help these cases. However, myomectomy is restricted to women with unexplained infertility. If you have fibroids growing into the uterine cavity then you are more likely to benefit after myomectomy. Higher pregnancy rates can be achieved after laparoscopic removal than open surgery. This procedure can be considered if you are suffering from infertility for long years.
Tubal sterilization is one of the most commonly used contraceptive methods worldwide. Approximately 1% of the women who undergo this procedure may request reversal of the procedure to restore fertility. However, if you are going for this procedure you must be aware of its cost benefit analysis. Due to its low success rate, often IVF is preferred to tubal anastomosis. Tubal anastomosis by the laparoscopic approach has the advantages over open surgery. Less postoperative discomfort and fewer complications, a smaller incisional scar, a shorter recovery time, and earlier resumption of normal activities are the advantages of laparoscopic procedure. This could be especially beneficial for a patient who previously has undergone a laparotomy or caesarean section because it allows her to avoid a second surgery.
Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.
Excision of endometriosis:
In women with minimal and mild endometriosis, surgical removal or thermal destruction(ablation) of endometriosis is recommended as first line with higher success rate.
Laparoscopic surgery for destruction of mild endometriosis almost doubles the spontaneous pregnancy rate. IVF is the best option for patients after failed primary surgery. Repeat surgery is associated with lower pregnancy rate.
The pregnancy rate after intrauterine insemination IUI may be increased after surgery for mild endometriosis. The place of IUI is limited in patients with moderate or severe endometriosis and in older women. The incidence of recurrence of endometriosis is not increased after ovarian stimulation for IVF.
Ovarian cysts commonly are simple cysts(functional)or chocolate cysts (endometrioma).
Functional cysts, unless they become very large, these types of ovarian cysts don’t affect fertility. Hence your doctor may prefer to wait and watch for growth of these cysts. Small cysts may regress on their own.
Ovarian endometriomas are managed by laparoscopic procedures, like cyst aspiration or excision.
Distal tubal disease and tubal reconstruction:
These procedures are of minimal benefit for fertility. At times these surgeries can be done for young patients with hydro salpinx who don’t want to go for IVF. Of all surgical treatments for tubal disease, sterilization reversal results in the highest pregnancy rates. The procedure is appealing to couples who desire an extended family or who are not comfortable with IVF. The ectopic pregnancy risk and the need for future contraception are recognized disadvantages with these procedures.
Benefits of bariatric surgery for obesity:
Obese men and women may benefit from weight loss programme or surgical removal of fat content from body.
Polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility. It is often associated with obesity. PCOS, hirsutism, and menstrual irregularities improve after bariatric surgery. The increased risk of miscarriage in obese women may decline after bariatric surgery.
Obesity can be associated with reduced sperm concentrations. Weight loss is the cornerstone of the treatment of obesity-related infertility. It can restore fertility and normal hormonal profiles. But effects of bariatric surgery impact on male fertility is still unclear. At times sperm counts may be adversely affected by fat loss surgery.
Laparoscopic adhesiolysis still remains a useful and effective procedure for infertile couples with pelvic adhesions. These adhesions may be a result of previous surgery or infections like abdominal tuberculosis.
Although septate uterus does not seem to be an infertility factor hysteroscopic septum resection is accompanied by a significant improvement in the reproductive performance. There is no adverse effect in the achievement of pregnancy in women with a history of recurrent abortions after septum removal.
Hysteroscopic septum resection in women with septate uterus significantly improves the live birth rates and future fertility is also not impaired.
Metroplasty refers to repairing the womb with birth defects like extra horn, double uterus or divided uterus. Women with uterine partition(septum) and otherwise unexplained infertility might benefit from hysteroscopic metroplasty.
Ovarian drilling is done in women with PCOS to break the thick outer surface and destroy some of the testosterone producing tissue made by the ovaries. This can help the ovaries release an egg each month and start regular monthly menstrual cycles. This may reduce symptoms of excess testosterone as well.
The uterine transplant is the surgical procedure whereby a healthy uterus is transplanted into an individual who does have one from birth or got it removed for disease process. Although it appears as a breakthrough procedure in the field of infertility its results are yet to be studied.
Surgery for Ectopic pregnancy:
Surgery for ectopic pregnancy usually involves the fallopian tubes. It is aimed at preserving the tubes for future fertility but recurrence of ectopic is common in such situations.
Fertility enhancing surgery in male infertility
Varicocele is one among the most common causes of male infertility. The adverse effect of varicocele on spermatogenesis can be attributed to an increased testicular temperature. The results of varicocele surgery are not conclusive and not encouraging for restoring fertility. Hence this is reserved for people with severe grade of the disease. ICSI is an alternative method of fertility treatment in these patients.
TESA, PESA, MESA & Testicularbiopsy:
These are procedures of sperm retrieval for patients undergoing ICSI treatment. Usually these procedures are advised in patients with azoospermia with blockage of the passage (vas deferens).
Reversal of vasectomy:
Vasectomy reversal is surgery to undo a vasectomy. Success rates with vasectomy reversal will range from about 40 percent to over 90 percent. In some cases, pregnancy, still may not happen after a vasectomy reversal, even when there is sperm. This may be due to decreased motility of sperm.