Surgical Infertility Treatment
Surgical infertility treatment overview
- Fertility surgery involves an operating procedure for men or women to correct a structural issue causing infertility, which may be due to a condition.
- Some causes of infertility in women that can be corrected by surgery include endometriosis, fibroids, polyps and other problems in the reproductive organs.
- For men, fertility surgery can treat varicocele or reverse a vasectomy.
- Hysteroscopy or laparoscopy are the two most common surgical approaches for female fertility surgeries.
What is fertility surgery?
There are many causes of infertility and some can be treated surgically to increase the chances for conception. Both men and women may need surgical infertility treatment. Some causes of infertility that require surgery are congenital, meaning the person is born with the structural abnormality and conditions that alter his or her reproductive system.
A physician certified in reproductive endocrinologist & infertility (REI) can help couples learn about their options and consider whether or not surgery is a viable treatment option for the cause of their infertility. The REIs at Loma Linda Center for Fertility and IVF are highly skilled in both nonsurgical and surgical treatments and will discuss with each patient the pros on cons of each option, landing on the best treatment for each person.
Most female fertility surgeries are completed using hysteroscopy or laparoscopy. These treatment options can also be used to diagnose the cause of infertility.
Hysteroscopy allows the surgeon to look at the lining of the uterus by inserting a small, lighted tube, called a hysteroscope, into the vagina. This procedure can be used diagnostically to find the cause of abnormal bleeding and examine the shape and size of the uterus for problems. At the same time, it can be used operatively to remove problems identified, such as uterine growths like small fibroids and polyps.
Laparoscopy used to treat infertility is a minimally invasive surgery that uses a system containing a small camera and operating instruments to see the reproductive organs (ovaries, fallopian tubes and uterus). The surgeon will make a minor incision in the abdomen to insert the camera that is used in the surgical procedure.
Female infertility conditions treated by surgery
Several female conditions that cause infertility can be treated by surgery. Once the fertility specialist has diagnosed the cause of infertility he or she may suggest surgery as a treatment option. REIs commonly use surgery when the cause is a blockage or a structural issue in the uterus, fallopian tubes or pelvic area.
Sometimes women are born with a uterine structural issue in which the uterus is not properly formed. A bicornuate uterus or a septum uterus are examples of this. These structural uterine issues and others can result in infertility. Often, surgery is the only treatment option to restore fertility.
A considerable benefit of many surgeries is that they can fix the cause of infertility at the time of the procedure, so in the future a woman can have multiple children if she desires. Some of the infertility conditions we most commonly treat by surgery are listed below.
Endometriosis causes tissue that grows on the inside lining (the endometrium) of the uterus to implant in other parts of the abdomen. This can make it difficult for some women to get pregnant. There are two surgical options to treat endometriosis, but only one is appropriate for women seeking to maintain their ability to have children.
The first is a conservative surgery done laparoscopically to remove as much of the endometrial tissue as possible to increase the odds of getting pregnant. The second option is a hysterectomy, which removes the uterus, rendering a woman unable to get pregnant and carry a child.
Fallopian tube blockage
A fallopian tube blockage can cause infertility because the egg and sperm cannot meet for fertilization or the fertilized egg cannot make it to the uterus to implant. Surgery depends on the location and extent of the blocked fallopian tubes. Here are the most common tubal procedures:
- Tubal reanastomosis. This surgery is used to reverse a tubal ligation or repair part of the fallopian tube that is damaged. The surgeon will remove the blocked or diseased portion of the tube, then connect the two healthy ends. It can be done through an incision in the abdomen or laparoscopically.
- Salpingectomy. This procedure removes part of the fallopian tube to improve in vitro fertilization (IVF) success when a tube has developed hydrosalpinx, a buildup of fluid.
- Salpingostomy. This surgery also treats hydrosalpinx by creating an opening in part of the tube closest to the ovary. It is common that scar tissue will regrow after this surgery, which can re-block the tube.
- Fimbrioplasty. This treatment option rebuilds the fringed ends of the fallopian tube that sweep the released egg into the fallopian tube when the end of that tube closest to the ovary is partially blocked.
- Tubal cannulation. This is used to open tubal blockages located close to the uterus. The doctor will insert a catheter through the vagina to the blocked fallopian tube. Once the blocked section is found, the doctor will open the area using a balloon on the catheter.
Uterine fibroids are benign lumps that grow in the uterus and can cause cramping, heavy bleeding, painful sex or an urge to urinate. They also cause problems with the fertilized egg attaching to the uterine lining. There are multiple options if treatment is needed to remove the lumps.
- Myomectomy. This is the best treatment option for women who want to get pregnant in the future. It removes the fibroids but leaves the healthy tissue in the uterus. This can be completed with an abdominal, hysteroscopic or laparoscopic approach.
- Myolysis. The doctor will cut the blood supply to the fibroid through heating, freezing or radiofrequency energy so the fibroid dies and shrinks.
- Uterine artery embolization. The surgeon inserts a catheter into the uterine artery and injects a substance that will cut off the blood supply to the fibroids, killing or shrinking them.
Uterine polyps, also known as endometrial polyps, are an overgrowth of cells that attached to the inner wall of the uterus. Uterine polyps affect fertility by interfering with implantation of an embryo and they also can cause miscarriage. Treatment for uterine polyps is called a polypectomy and includes surgical removal of the polyps during a hysteroscopy procedure.
Pelvic adhesions are bands of scar tissue that can cause major problems with fertility. Adhesions surrounding the ovary may impair the ability of an egg to reach the tube after ovulation. Adhesion of the tube can prevent the sperm from reaching the egg or an embryo from reaching the uterus. Adhesions are commonly a result of previous surgery or can accompany severe stages of endometriosis. Pelvic adhesions are most frequently removed using a laparoscopic procedure.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects ovulation and is commonly found in women of reproductive age. There are two surgical procedures used to treat PCOS.
- Laparoscopic ovarian drilling. This procedure uses a laser or electrocautery to destroy parts of the ovary, which may trigger unintended ovulation.
- Ovarian wedge resection. This is a surgical way to remove part of the ovary. This procedure can cause scarring on the ovary damaging it, so this is rarely performed as a fertility option due to that risk.
Egg retrieval is the process by which the eggs for an IVF procedure are removed from the ovarian follicles using a thin needle. The needle is gently inserted into the follicle, guided by ultrasound, and the egg is aspirated into the needle and removed from the ovary.
Male fertility surgeries
Men may also need surgery to correct structural issues causing infertility. We partner with Dr. Edmund Ko of the urology department for all male infertility cases that need surgery. Types of surgeries to improve or reverse infertility in men include a vasectomy reversal and a varicocelectomy.
A vasectomy reversal or vasovasostomy will reconnect the vas deferens, which was disconnected during the vasectomy. A small incision is made in the testicle. The reconnected vas allows sperm to once again enter the seminal fluid.
Varicocelectomy treats varicocele, which is an enlargement of the veins in the scrotum that disrupts a man’s fertility. This surgery removes those enlarged veins to restore normal blood flow to the reproductive organs. Varicocele is not always treated, but surgery may be recommended if it is causing infertility.
If the man’s semen carries no sperm, there may be a structural problem preventing sperm from being released into the semen during ejaculation. Sperm retrieval techniques are done by our urology partner at the university and can be completed using microsurgical epididymis sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).
Similar to an egg retrieval in a woman, the sperm can then be used for IVF, ICSI, or cryopreservation.