Reproductive health is an essential component of women's general health. Reproductive health care is considered as a precondition for women's social, economic and human development. When our ladies lack access to safe and secure reproductive health care, the consequences can be quite damaging.
When women try conceiving and find it difficult and seek help for infertility, they discover a wide array of available tests and treatments. While the whole thought process of a surgery could be frightening, reproductive surgery is one of the most successful options that we now have, to help achieve pregnancy.
Recent advances and wide application of ART techniques such as IVF and ICSI has changed the ﬁeld of reproduction, particularly regarding reproductive surgery. Indeed, a rather cryptic ﬁeld to begin with, practiced by very few physicians, with a very long learning curve due to the delicacy of some of the procedures done under microscopy, reproductive surgery was limited by the better results promised by IVF. However the reproductive surgeries still remain an integral part of a successful IVF Center.
How Can Surgery Help?
In few cases, an anatomic problem would prevent a couple from conceiving. Reproductive Surgery in most cases can help fix the obstruction, whether it's a scarred tube or an abnormally shaped uterine cavity. In men, varicoceles condition can often be a problem. Men and women who have undergone sterilization (vasectomy or tubal ligation) may also undergo surgery to try to regain fertility.
Which Surgery Is Done For Which Problem?
Doctors may recommend a surgical treatment based on the patient, her fertility problem, and the method with which the surgeon is most comfortable. If the surgery goes smoothly, most fertility procedures can be done on an outpatient basis.
- Fallopian Tube Abnormalities :Tuboplasty
- Uterine Abnormalities :Metroplasty / Unification
- Ovarian Cysts : Ovarian Cystectomy
- Endometriosis : Conservative Surgery for Endometriosis
- Fibroids : Myomectomy
- Adhesions :Adhesiolysis
- Tubal Recanalisation / Reversal of Tubal Ligation.
Fallopian Tube Abnormalities: Tuboplasty
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes, leading from the ovaries into the uterus. The fallopian tubes are the path that the sperm and egg must take to achieve fertilization and successfully implant in the uterine cavity. Disorders of the fallopian tubes can lead to the inability to conceive, because the sperm and egg cannot meet. While a full testing of tubal functions in patients with infertility is not possible, testing of tubal patency is important as tubal obstruction is a major cause of infertility.Prior pelvic infection, surgery, or endometriosis can lead to blocked fallopian tubes. Laparoscopy is used to diagnose and treat these disorders. In some cases, severely damaged fallopian tubes must be removed to give a woman her best chance to conceive with in vitro fertilization because fluid buildup in the fallopian tubes can create a toxic environment for implantation. In other cases, pelvic scaring and endometriosis can be treated to improve a patient's chances of conceiving naturally or with less aggressive fertility treatments.
Uterine Abnormalities :Metroplasty / Unification:
The reproductive function of the uterus is to accept a fertilized ovum.The uterus is the organ where the embryo implants and develops throughout a pregnancy. The embryo implants into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. Uterine abnormalities can contribute to decreased fertilization, miscarriage, or pregnancy complications. Common uterine abnormalities requiring surgical treatment include polyps, scarring, fibroids and septums. Many of these abnormalities can be treated using hysteroscopy and/or laparoscopy, but some may require more extensive surgery depending on the patient's condition. Uterine fibroids are very common among women of reproductive age and not all fibroids need to be removed in order to achieve a successful pregnancy.
Ovarian Cysts : Ovarian Cystectomy:
Ovarian cysts are a frequent finding in women of reproductive age. Many of them resolve on their own and do not require surgery. Cysts that are large or persistent, lasting more than 2 to 3 months may require surgery. Most ovarian cysts are non-cancerous and may be due to endometriosis or other benign processes. Cancer is rarely found in women of reproductive age with simple ovarian cysts, but surgical removal and microscopic examination is the only way to definitively diagnose the type of cyst. Ovarian cysts can typically be removed laparoscopically, and do not require removal of the entire ovary. Other ovarian disorders, such as polycystic ovarian syndrome, can be treated medically or surgically.
Endometriosis : Conservative Surgery for Endometriosis:
Endometriosis is a gynecologic condition characterized by endometrial tissue from the inner lining of the uterus, growing outside of the endometrial cavity. Typical symptoms of endometriosis are painful menstrual periods, vaginal bleeding between periods, and infertility; however, some women with infertility associated with endometriosis have no symptoms. Laparoscopy can be used to diagnosis and treat endometriosis in a single procedure. Although the exact mechanism of how endometriosis causes infertility remains poorly understood, the strong association between endometriosis and unexplained infertility exists and many studies have shown that treatment of endometriosis can improve fertility in women attempting to conceive on their own and with fertility treatments.
Tubal Recanalisation/ Reversal of Tubal Ligation:
For women who wish to reverse a previous sterilization, the surgeon may use laparoscopy or laparotomy with microsurgery. At present, around the World, tubal sterilization is the most popular form of birth control. However such a woman may seek reversal due to unexpected events such as death of the child. Advanced microsurgical techniques for reversal of tubal ligation minimize injury to delicate tissue in and around fallopian tubes and helps to ensure clear passage within the tubes for the sperm and the ovum. This improved surgical technique has resulted in live births in more than 50% of cases at our hospital. The overall success in terms of intrauterine pregnancy after reversal of sterilization by microsurgery varies from 60-80%. Although microsurgical reversal achieved 100% patency rate in our patients, certain factors, like duration of sterilization, technique of sterilization, and the length of the tube remaining after reversal, played a crucial role in deciding the pregnancy rate. Therefore, patients who had tubal length > 4cm and had time interval between sterilization and reversal of < 5 years resulted in better pregnancy rate. Although the microsurgical technique has its own limitations, its proper application has brought a ray of hope to women seeking sterilization reversal.
For men who are infertile, the conditions that require surgery are more limited:
Varicocele repair (also referred to as varicose veins in the scrotum): The surgeon makes a small incision, ties off the varicose vein, and restores fertility. A new treatment is being studied which involves blocking blood flow to the affected veins. A tiny incision is made in the leg or neck of the patient where a catheter is inserted and the doctor then releases pellets to block blood flow to the varicose vein.
Reversal of vasectomy: This surgery needs to be performed by a surgeon experienced in microsurgery.