Laparoscopy for Infertility
Laparoscopy overview
- Laparoscopy for infertility is a minimally invasive surgical procedure in which a telescope-like instrument (laparoscope) with light and small camera allows the surgeon to examine the pelvic anatomy for causes of female infertility.
- Laparoscopy can be diagnostic, assessing for causes of infertility in the uterus, fallopian tubes and ovaries.
- An operative laparoscopy involves surgical treatment for problems found during a diagnostic laparoscopy procedure, utilizing small surgical tools passed through the laparoscope.
- Laparoscopic surgery can also be used to remove scar tissue or endometriosis.
What is laparoscopy for infertility?
Laparoscopy for infertility is a minimally invasive surgical procedure that uses a laparoscope (a fiber-optic tube with light and video camera) inserted through two or more minor incisions, often in the belly button. The surgeon can then visually examine the pelvic reproductive organs and the pelvic cavity.
The procedure may be performed under general anesthesia or local anesthetic and typically takes 30 to 45 minutes. The abdomen is inflated with gas (carbon dioxide or nitrous oxide injected with a needle) to move the organs away from the abdominal wall so that they are visible during the procedure.
Once the abdomen is inflated, the laparoscope is inserted through the small incisions. The surgeon views the interior of the pelvic cavity on a video screen transmitting the images from the camera.
The surgeon will look for possible causes of infertility. These could be:
- Abnormalities of the uterus and ovaries
- Blocked fallopian tubes
- Scar tissue
- Fibroid tumors
- Endometriosis (which can only be confirmed via laparoscopy).
The surgeon may decide to correct problems detected. This becomes an operative laparoscopy, and small surgical instruments are manipulated through the laparoscope or another small incision point. The surgeon can remove scar tissue, fibroids or endometrial tissue that has incorrectly implanted outside the uterus. The surgeon cuts tissue or removes it with a laser beam or electric current (electrocautery).
The surgeon closes the incision in the abdomen with a few stitches. There is usually little or no scarring.
When is laparoscopy used for treating infertility?
Laparoscopy for infertility is generally only performed after other fertility tests have not resulted in a conclusive diagnosis. For this reason, laparoscopy is often performed on women with unexplained infertility.
Laparoscopy also allows for biopsy of suspect growths and cysts that may be hampering fertility. Laparoscopy may be recommended for women experiencing pelvic pain, which is a potential symptom of endometriosis. Laparoscopy can also remove scar tissue that can be a cause of pelvic or abdominal pain.
Risks of laparoscopy
Like any surgery, laparoscopy for infertility has potential risks. Only 1-2 percent of patients who undergo laparoscopy for diagnosing or treating infertility experience a complication, including anesthesia-related issues. Minor complications include infection and skin irritation at the incision.
More severe complications may include:
- Formation of adhesions and hematomas (a swelling due to blood outside a vessel)
- Allergic reaction
- Nerve damage
- Blood clots.
In some instances, an instrument or laparoscope may cause injury to an abdominal or pelvic organ, such as the bowel or bladder. While injury may occur in any patient, it is more common in women who have undergone previous abdominal surgery, pelvic adhesions, or who are overweight.
If injury occurs, a larger incision would be used to repair the damaged organ and would result in hospitalization for recovery. In rare instances, damage to an organ may not be discovered during surgery. This would lead to an emergency surgery and, if the bowel has been damaged, temporary placement of a colostomy.