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Surgery

Reproductive surgery plays a much smaller role in the treatment of infertility now than it did twenty years ago when the success rates of IVF were considerably lower. Nonetheless, there are well-defined areas where surgical intervention either alone or in conjunction with other treatments, such as IUI or IVF, is appropriate.

In select cases micro-surgical reversal of tubal ligation or vasectomy frequently results in restoration of fertility and is more cost-effective than IVF. The photo below shows a reconnected left Fallopian tube (at arrow) with patency demonstrated by free flow of blue dye.

Reconnected Left Fallopian Tube

Reconnected Left Fallopian Tube

Uterine fibroids and endometrial polyps are frequent findings which may interfere with embryo implantation regardless of how conception occurs. Fortunately, the most problematic fibroids occur within the uterine cavity and can usually be removed with hysteroscopy on an outpatient basis. Fibroids arise from the myscle layer of the uterus. The pictures below show a large submucous fibroid being resected with an electric loop. The patient had a successful spontaneous conception shortly after surgery.

Submucous Fibroid
Submucous Fibroid

Endometrial polyps arise from the gland layer lining the uterine cavity. Large polyps can be apparent on vaginal ultrasound (lower picture) while smaller polyps usually are  seen on saline infusion a sono-hysterogram (upper picture). Hysteroscopic removal of all polyps is recommended before IVF and other advanced treatments.

Small Polyp
Small Polyp

Large Polyp
Small Polyp

Sessile Posterior Polyp
Sessile Posterior Polyp

Laparoscopic treatment of pelvic adhesions and endometriosis may be helpful in certain circumstances but severe tubal disease, such as distal tubal occlusion (What Is a Hydrosalpinx?) is best approached through IVF after severing the connection of the tube to the uterine cavity. The picture below demonstrates normal pelvic anatomy.

Normal Pelvic Anatomy
Normal Pelvic Anatomy