Learn about infertility surgery, including Tubal Reversal, Vasectomy Reversal and more
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Your infertility treatment may include surgical procedures. Surgery can
be used to diagnose and treat anatomical problems or in technologies that
bypass those problems.
Surgical procedures for women include diagnostic hysteroscopy, diagnostic
laparoscopy, tubal reversal, assisted reproductive technology procedures
(GIFT and ZIFT), and reconstructive pelvic surgery. Highly trained and
experienced doctors can often use minimally-invasive surgery instead of
abdominal surgery to minimize pain, scarring, and recuperation time.
Procedures for men, usually performed by a urologist, include vasectomy
reversal, removal of obstructions, sperm aspiration, and varicocele
repair.
Procedures for women
Several surgical procedures can help you improve your chances for
pregnancy. Abdominal surgery was the traditional way to gain access to
the internal pelvic organs. Now, most procedures can be done using
laparoscopy or hysteroscopy. These less-invasive procedures minimize
scarring and recovery time as well as complications.
Diagnostic hysteroscopy
Your doctor may use a hysteroscopy for diagnosis if your ultrasound exam
suggests problems inside the uterus or gives incomplete information. A
hysteroscopy allows your doctor to examine the uterus for scar tissue,
polyps, or fibroids. A telescope-like device is passed through the
cervix. Hysteroscopy requires no incision, and patients usually recover
quickly.
If any problems are found, your doctor may be able to correct them during
the initial hysteroscopy. Follow-up may be necessary with a separate
operative hysteroscopy or other surgical procedure.
Diagnostic laparoscopy
With a few small incisions, your doctor can see inside your abdomen to
the outside of the uterus, the fallopian tubes, the ovaries, and the
bladder. A viewing device (the laparoscope) is passed through one of the
incisions.
The laparoscope can help your doctor diagnose uterine fibroids (in the
wall of or outside the uterus), endometriosis, ovarian cysts, and other
fertility problems. These problems can often be treated during the
laparoscopy. In some cases, follow-up surgery may be required.
Most women recover within a few days. The small incisions are normally
made at the navel and at the pubic hair line and rarely leave noticeable
marks.
Tubal reversal
Some women who choose sterilization for contraception later wish to
become pregnant. A new marriage, other life change, or a new outlook may
prompt this change of heart. Tubal ligation, a "permanent sterilization"
procedure, can be reversed. In other cases of female sterilization, IVF
is usually the best option.
In tubal reversal, the surgeon uses laparoscopy or abdominal surgery to
repair the tubes. It is an outpatient procedure. Scar tissue is removed,
the ends of each tube are prepared, and the tube is reconnected with tiny
sutures. Since the fallopian tubes are extremely delicate, success - and
future fertility - depend on the ability of the surgeon. After a
successful reversal, youÕll have up to a 75 percent chance of pregnancy.
Dr. Donald Galen of the Reproductive Science Center® of the Bay Area
performed the first robotic computerized tubal reversal. Robotics allows
meticulous control and even the possibility of remote surgery, with the
patient and surgeon thousands of miles apart.
ART procedures
In some cases, your doctor may recommend an assisted reproductive
technology that requires surgery. For example, your cervix may be scarred
in a way that prevents success with standard embryo transfer after IVF.
Your doctor may use a laparoscopy to place the embryos or a sperm/egg mix
into your fallopian tubes. In ZIFT (zygote intrafallopian transfer) the
doctor places embryos into one of the tubes. In GIFT (gamete
intrafallopian transfer). the unfertilized eggs and sperm are transferred
into a tube.
Recovery normally takes a week or less.
Reconstructive pelvic surgery
Some women are born with an improperly developed uterus. These problems
occur naturally in a small percentage of women, and some of them lead to
infertility or miscarriage. Surgery may correct them.
Nonsymmetrical development of the uterus - When a female fetus develops,
the two sides of her uterus begin to form, then fuse together from the
bottom up. Sometimes, they don't fuse, resulting in an abnormal cervix or
a closed-off portion of the uterus, called a blind horn.
For women born with this condition, menstrual fluid can't get out of the
blind horn and pregnancy rates are lower. A laparoscopy or hysteroscopy
can be used to remove the blind horn or open it up to the uterus so that
it can function normally.
Uterine septum - Sometimes a dense layer of tissue grows and divides the
uterus into two working halves. These women have decreased pregnancy
rates and higher miscarriage rates. An operative hysteroscopy can
sometimes be used to remove the dividing layer.
Procedures for men
Some men don't produce sperm in their ejaculate. This condition,
azoospermia, can be caused by a vasectomy, a natural obstruction that
traps the sperm, or improper sperm development. In some cases, outpatient
surgery can help these men become fathers.
Vasectomy reversal
The urologist makes a small opening in the scrotum. The obstruction is
found, scar tissue is removed, and the ends of the tubes are open and
reconnected. The procedure usually takes about three hours. You may be
sore for several weeks. If pregnancy doesn't occur within a few months,
you may wish to pursue further fertility treatment.
Obstructive azoospermia
Some obstructions that trap sperm can also be surgically corrected. For
non-operable obstructions or failed vasectomy reversals, the urologist
can use sperm aspiration. The urologist locates the obstruction, then
uses a small needle to draw out sperm from near the obstruction. If sperm
aren't found, the next step is to take a small sample of testicular
tissue (a testicular sperm biopsy), which may contain sperm.
The sperm can be used immediately - or frozen - for an IVF cycle. In IVF
with ICSI (intracytoplasmic sperm injection), only one sperm is needed
for each egg.
Nonobstructive azoospermia
If you don't produce any mature sperm (a condition called nonobstructive
azoospermia), a testicular sperm biopsy may help. A small needle puncture
is used to remove a tiny portion of the testicular tissue. The sperm are
then dissected out of the tissue. If insufficient sperm are found in the
small sample, a larger biopsy may be performed. Almost all men have some
sperm.
Since IVF with ICSI requires only one sperm for each egg, most of these
men have enough sperm to have a genetic child. Pregnancy rates may be
lower than for men with obstructive azoospermia.
Varicocele repair
This is becoming a less-used procedure. It is believed that an enlarged
vein - essentially a varicose vein - around a testicle can raise its
temperature, thus suppressing sperm count. In varicocele repair, the
urologist ties off the vein. After surgery, sperm count usually increases
within a few months, but pregnancy rates don't seem to improve.
See a fertility specialist now
We're a national network of over 100 fertility specialists.