Your fertility doctor at SCRC will help you determine whether medical or surgical infertility treatments are best for you. For some patients, surgical fertility treatments are required. For women, these include the removal of uterine fibroids and the removal of endometriosis tissue. Surgical treatments for men include vasectomy reversal and varicocele repair, a procedure treating varicose veins in the scrotum.

To understand some of your options, here are the general categories of surgical fertility treatments:

• Minimally Invasive Surgery
• Infertility Laparoscopy
• Hysteroscopy
• Transvaginal Hydrolaparoscopy (THL)
• Evaluation of the Lining of the Fallopian Tubes
  • Salpingoscopy
  • Falloposcopy

Minimally Invasive Surgery

Infertility can be caused by a variety of pelvic problems including birth defects, fibroids, polyps, and pelvic adhesions. Our physicians are highly skilled in the surgical and micro-surgical techniques used to correct these conditions, and our surgical facility is fully equipped and staffed for all these infertility procedures. Our goal is to perform surgery in the least invasive way, but with the goal of restoring conditions necessary for a successful pregnancy.

Infertility Laparoscopy

Laparoscopy is considered the gold standard for the detection of tubal disease, and should be considered in any patient with risk factors such as a history of sexually transmitted disease, pelvic inflammatory disease, previous pelvic surgery, or appendectomy.

Laparoscopy is a surgical procedure that allows the surgeon to view and treat anatomic abnormalities by using a very small fiber-optic lens inserted through a small incision in the navel. If necessary, additional small incisions are made to allow the use of other specialized surgical instruments during the procedure.For an infertility laparoscopic procedure, the abdomen is filled with carbon dioxide gas, causing the cavity to expand, giving the surgeon a clear view of the reproductive organs. Laparoscopy allows the doctor to evaluate the outside of the uterus and fallopian tubes. The procedure is performed under general anesthesia. Compared to procedures performed with larger abdominal incisions, laparoscopies typically result in less discomfort and pain and reduced recovery time. Laparoscopic patients typically can return to normal activities after only two to three days of recovery.

A laparoscopic procedure may be the appropriate choice for the:

• Evaluation of infertility
• Diagnosis and treatment of endometriosis
• Treatment of ovarian cysts
• Removal of uterine fibroids
• Removal of adhesions

Many diseases and abnormalities of the abdomen and pelvis can be safely treated using laparoscopy. With special laparoscopic instruments, the surgeon can incise, biopsy, cauterize, or vaporize problem areas without the need for a large abdominal incision. For example, adhesions or endometriosis treatment can include laparoscopy. Laparoscopy is done during the early part of the menstrual cycle to avoid disruption of possible early pregnancy.

Hysteroscopy

Hysteroscopy is a surgical procedure used for looking within the uterine cavity (diagnostic laparoscopy) and performing necessary sampling (biopsies) and corrections (operative laparoscopy). The procedure consists of gently dilating the canal of the cervix, and inserting a narrow viewing instrument (hysteroscope) directly through the canal into the uterine cavity. Hysteroscopy allows for direct and clear visualization of the cavity, and enables treatments of abnormalities such as polyps, fibroids, and projections of the uterine wall.

Transvaginal Hydrolaparoscopy (THL)

Transvaginal hydrolaparoscopy is a minimally invasive procedure that allows the doctor to view the pelvic structures, such as the exterior of the uterus and tubes, without the need for an abdominal incision. The THL procedure consists of making a small incision in the vagina directly behind the cervix. A narrow viewing instrument (endoscope) can be inserted through this incision to enter the pelvis directly behind the uterus.

THL can be done with minimum anesthesia and no abdominal incisions. It can also help determine the need for laparoscopy.

Evaluation of the Lining of the Fallopian Tubes

Blockages or disease of the interior of the fallopian tubes (the tubal mucosa) can be viewed with special instruments during procedures called salpingoscopy and falloposcopy.

Salpingoscopy

Salpingoscopy is performed at the time of laparoscopy, and involves the insertion of a viewing instrument called the salpingoscope through the ends of the Fallopian tubes. This enables a view of the distal portion of the tubal mucosa, and helps to diagnose areas of thinning (denudation) and scarring (adhesions) within the tube.

Falloposcopy

During falloposcopy, a thin and flexible microendoscope called the flexible falloposcope, is inserted through a tubal opening called the ostium and advanced using a guiding catheter. This technique allows the doctor to view the entire length of the fallopian tube and check for the presence of adhesions, denudation, and blockage. Procedures to correct blockage can also be performed during falloposcopy.

To determine which, if any, of these options for surgical fertility treatments are right for you, contact the specialists at the Los Angeles fertility clinic, SCRC, and schedule a consultation.