Infertility Treatment Clinic Mumbai
Laparoscopy In Infertility
Infertility is the inability to conceive a pregnancy within a specified amount of time usually two years. Most couples seek medical assistance after an year or so. Laparoscopy has proven to be a boon for couples with infertility helping treat, in conjunction with hysteroscopy, many pathologies.
Laparoscopy, along with hysteroscopy, is indicated in infertile women in the following situations:
- Ultrasound or X-ray of the uterus (hysterosalpingogram) revealing an abnormality of the pelvis
- Long standing infertility
- Clinical evidence of pathology (fibroids or ovarian cysts)
- To treat a pathology which is associated with poor pregnancy outcome such as an uterine septum
The following surgeries can be performed with laparoscopy :
- Diagnostic endoscopy: with excellent tools for diagnosing most gynecological conditions, laparoscopy should rarely be needed as a diagnostic tool except in couples with long standing, unexplained infertility.
- Endometriosis : Endometriosis is growth of the endometrium (lining of he uterus) outside its normal location in the uterine cavity usually in the pelvis on the ovaries, intestines and outer surface of the uterus. This causes adhesions and distortion of normal anatomy. The primary treatment of endometriosis is laparoscopy. During surgery, we excise endometriotic tissue, remove endometriotic cysts of the ovary (endometriomas or chocolate cysts), lyse adhesions and restore organs back to relatively normal anatomy. Surgery itself improves the results of subsequent treatment of infertility.
- Uterine fibroids: Uterine fibroids encroaching on the uterine cavity, extremely large fibroids (more than 5-7cm) and fibroids at the side of the uterus where they can compress the ovaries and Fallopian tubes require removal prior to treatment of infertility. Laparoscopic myomectomy is the gold standard of treatment today.
- Adenomyosis: Extensive adenomyosis of the uterus (ingrowth of endometrium in to the uterine muscle) may be associated with subfertility. Large localized adenomyosis (adenomyomas) and extensive adenomyosis can be excised rapidly with laparoscopy and has been shown to be associated with favorable pregnancy outcome.
- Ovarian cysts: Large ovarian cysts may interfere with treatment of infertility and these can be excised with preservation of sufficient amount of ovarian tissue by laparoscopy.
- Ovarian drilling: Polycystic ovarian disease is a hormonal problem associated with anovulation (failure of the egg to come out of the ovary). This is primarily treated with medication. Laparoscopic ovarian drilling involves drilling of multiple holes in the ovary with an electrode. This is performed when medical treatment fails to induce ovulation, when ovulation does not result in a pregnancy and in women with otherwise unexplained repeated miscarriage.
- Adhesiolysis: Adhesions (ca condition where the organs stick to one another) can form in the abdomen and pelvis due to infection (tuberculosis or pelvic inflammatory disease), endometriosis and previous surgery. These adhesions can alter normal anatomy and interfere with ovulation & function of the Fallopian tube. Cutting these adhesions may improve chances of pregnancy following medical treatment if the Fallopian tubes are healthy and patent.
- Tuboplasty: In women who have a segment of the Fallopian tubes removed (for sterilization), the remaining segments (if healthy) can be united with very fine sutures. Laparoscopic tuboplasty is the gold standard surgery today and is associated with excellent pregnancy rates.
Advantages of laparoscopy in infertility include:
- Direct visualization of the abdomen and pelvis
- Minimally invasive with very low incidence of adhesion formation
- Enables diagnosis and treatment of pathology at one sitting