What to know about laparoscopy, hysteroscopy in the management of infertility
There was a time when doctors had to open a woman to treat the probable cause of infertility, but that all changed with the introduction of laparoscopy.
This is a type of surgery that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery.
Generally, laparoscopy is a minimally invasive surgical technique used in the diagnosis and treatment of infertility. It is the gold standard in the diagnosis of tubal pathology and other intra-abdominal causes of infertility.
If you’re having trouble conceiving, a laparoscopy can see any abnormalities that might be interfering with your ability to conceive. Diagnosis of infertility and operative laparoscopy help assess and treat gynecological problems such as uterine fibroids, structural abnormalities of the uterus, endometriosis, ovarian cysts and adhesions.
Today, the diagnosis and treatment of infertility is emerging as one of the fastest growing areas of medicine. Most tests like ultrasound (trans-abdominal and vaginal) and hysterosalpingography (HSG) are likely to miss intra-abdominal abnormalities such as adhesion, endometriosis, exact ovarian pathology, and tubal conditions that can be easily demonstrated by laparoscopy.
The ability to see and manipulate the uterus, fallopian tubes, and ovaries during laparoscopy has made it an essential part of an infertility assessment. It’s good to know.
There is indeed a lot to know about laparoscopy which, basically, can be described as an operation involving small cuts on a woman’s stomach. A thin telescope measuring 5 mm or 10 mm in diameter is inserted inside the belly to check if the fallopian tubes are open and if there are other problems not detected.
This helps to visualize your reproductive organs (uterus, tubes, ovaries and the rest of the pelvis and abdomen) on the screen. In addition, three small incisions 5mm in length may be needed on the stomach to insert other instruments needed during laparoscopy. This procedure visualizes the pelvic organs.
If there is a problem, such as a tubal block, fibroid, or endometriosis, it should be treated at the same session. If the facilities and skills do not exist for the operative part, this part should be performed again at a later date. This leads to doubling the effort and it is advisable to avoid it. In some women, this operation is performed repeatedly and leads to increased pain and costs.
As stated, the main role of laparoscopy is to improve IVF success rates. For example, a proper transvaginal ultrasound is crucial in diagnosing tubal disease, ovarian abnormalities, uterine factors, and other pelvic abnormalities that can negatively affect an IVF cycle.
Tubal disease includes infections that lead to the accumulation of fluid in the tubes (hydrosalpinx), the ovaries may have cysts, and the uterus may have fibroids and polyps. If the ultrasound has detected any of the above abnormalities, laparoscopy becomes necessary to improve the outcome of the IVF cycle.
If the fallopian tubes are infected and filled with fluid, they must be disconnected from the uterus. Otherwise, the unhealthy fluid can prevent embryos from implanting in the uterine cavity. It is important to ensure that both ovaries are free and located normally so that they are easily accessible for the egg retrieval procedure.
The ovaries may be adherent due to adhesions resulting from conditions such as endometriosis, pelvic infections, and previous surgeries. In these situations, laparoscopy can help break up these adhesions and free the ovaries.
If your uterus has fibroids that are large and located in the cavity or near the wall of the uterus, it may be advisable to remove them. These advanced procedures require special skills and are only performed in highly specialized units.
Fortunately, most women recover quickly from this procedure and can return to normal life within 48 hours. Most can go home the next day. Major surgeries may take a few extra days for a full recovery. A slight discomfort may be felt in the stomach during the first days after the operation.
Laparoscopy is a commonly performed operation with rare complications and an incidence of less than 1 in 1000 patients. They are seen more in patients with risk factors such as previous surgery with a vertical midline incision, surgery anterior complicated abdominal, etc.
Hysteroscopy, on the other hand, is an operation in which a thin telescope is inserted into the cavity of the uterus through its cervix. Visualization of the uterine cavity and identification of possible pathology has made hysteroscopy an equally important tool in the assessment of infertility.
The issue of tubal morphology and patency, ovarian morphology, any unsuspected pelvic pathology, and uterine cavity abnormalities can all be accurately resolved in one sitting.
The bottom line is that laparoscopy and hysteroscopy have an important role in improving the success of IVF treatment. Hysteroscopy is beneficial in almost all patients undergoing IVF treatment, while laparoscopy is performed selectively as directed.
Modern technology and improved instrumentation have increased the efficiency of these procedures. Improved imaging systems, better and safer energy sources for operative procedures have increased the role of hysteroscopy and laparoscopy in maximizing the success of IVF treatment.
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