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Gynaecological Surgery and Fertility
Surgery plays an important role in managing certain gynaecological conditions that can affect fertility or cause symptoms such as abnormal bleeding or pain. Understanding these conditions and the surgical options available can help individuals make informed decisions about their reproductive health.
A laparoscopy, often called keyhole surgery, is a minimally invasive procedure used to look inside the abdomen and pelvis. It involves making small incisions (usually 0.5 to 1 cm) in the abdomen through which a thin, lighted telescope called a laparoscope is inserted. The laparoscope transmits images to a screen, allowing the surgeon to see the pelvic organs clearly.
Laparoscopy can be used both to diagnose conditions like endometriosis, fibroids, ovarian cysts, and adhesions, as well as to perform surgery to treat these conditions. It generally results in smaller scars, less pain, a faster recovery, and fewer complications compared to open surgery.
The procedure is done under general anaesthesia. Gas is used inside the abdomen to create space for viewing and surgery. After the procedure, most patients can go home the same day or the next day.
What is a Laparoscopy?
A hysteroscopy is a minimally invasive procedure used to examine the inside of the uterus (womb). A slender telescope called a hysteroscope is passed through the vagina and cervix into the uterus, allowing direct visualization of the uterine cavity.
Hysteroscopy is primarily used to diagnose and treat problems such as uterine polyps, fibroids inside the uterine lining, adhesions (scar tissue), recurrent pregnancy loss, recurrent implantation failure and abnormal bleeding.
Through hysteroscopy, surgeons can remove polyps or small fibroids, and perform procedures to restore normal uterine anatomy, which can improve fertility and reduce symptoms.
Both laparoscopy and hysteroscopy are key tools in modern gynaecology, enabling precise diagnosis and treatment with minimal disruption and quicker recovery.
What is a Hysteroscopy?
If you are experiencing fertility challenges, a consultation with a gynaecologist or reproductive surgeon can help identify if surgery may be a beneficial part of your treatment plan. Surgical approaches are tailored to each individual’s condition and fertility goals to optimise reproductive outcomes.
Common Conditions Where Surgery May be of Benefit
Background:
Fibroids are non-cancerous growths of the muscle tissue in the uterus and are very common, affecting up to 70% of women by age 50. While many fibroids do not cause symptoms, those that distort the shape of the uterine cavity can interfere with implantation and increase the risk of miscarriage.
Effect on Fertility:
Fibroids that alter the uterine lining or block the fallopian tubes can reduce fertility or contribute to recurrent pregnancy loss.
Surgical Options:
Surgical removal (myomectomy) is offered when fibroids cause significant symptoms or fertility issues. Myomectomy can be performed laparoscopically, hysteroscopically, or via open surgery depending on fibroid size and location, with the goal of restoring normal uterine anatomy to improve fertility outcomes.
Fibroids
Background:
Endometrial polyps are growths in the lining of the uterus. They are common in women experiencing abnormal bleeding and infertility.
Effect on Fertility:
Polyps can interfere with embryo implantation.
Surgical Options:
Polyps are usually removed via hysteroscopy, a minimally invasive outpatient procedure. Removing polyps often improves fertility.
Polyps
Background:
Endometriosis affects around 10-15% of reproductive-age women but around 50% of those with otherwise unexplained infertility. It occurs when uterine lining tissue grows outside the uterus, leading to inflammation, pain, and scarring.
Effect on Fertility:
Endometriosis can cause distortion of reproductive organs, adhesions, and inflammation that impair egg release, sperm movement, or embryo implantation.
Surgical Options:
Laparoscopy is used to remove or ablate endometriotic lesions and adhesions, improving rates of natural conception, particularly in mild to moderate cases. Surgery on ovarian endometriomas (cysts) is done with care to preserve ovarian reserve. Repeat surgeries are generally avoided as they may reduce ovarian function and do not improve fertility.
Endometriosis
Background:
Pelvic adhesions are bands of scar tissue that can form after surgery, infections, or inflammation, binding organs together abnormally.
Effect on Fertility:
Adhesions can distort pelvic anatomy, block fallopian tubes, and impair egg transport.
Surgical Options:
Laparoscopic surgery can dissect and remove adhesions, restoring normal anatomy and improving fertility outcomes.
Adhesions
What is it?
A tubal flush at the time of laparoscopy is a diagnostic procedure used to evaluate the patency of the fallopian tubes. It involves injecting fluid through the cervix into the uterus and fallopian tubes to assess whether it flow freely through them and confirms they are open and functioning. Risk factors for blocked fallopian tubes include endometriosis, previous pelvic infection and surgery.
Tubal Flush (Diagnostic Procedure)