Krishna IVF Clinic is a multilingual, state-of-the-art IVF Lab and Fertility Clinic that offers personalised care with latest technology needed to manage infertility & reproductive disorders.
Surgery for women:
If you require surgery as part of your fertility treatment, either conventional open surgery or keyhole surgery may be offered.
Keyhole surgery – where possible, your clinic is likely to recommend keyhole surgery (laparoscopy) as this is a less invasive procedure and scarring is minimised. Keyhole surgery uses a 1cm cut in the umbilicus (tummy button) and two or three smaller cuts close to the pubic hair line. This type of surgery usually requires a general anaesthetic.
Conventional surgery – usually uses a ‘bikini-line’ cut about 10 cm long. This type of surgery usually requires a general anaesthetic. A general anaesthetic is usually required.
Your history and / or examination may indicate possible causes of your infertility that require investigation. For example:
• If you have stated that there is pain superficially at penetration preventing satisfactory intercourse, examination may reveal that the entrance to the vagina is very tight and that full penetration has never occurred.
• Your periods may be becoming increasingly heavy and on examination the uterus is enlarged by a mass of fibroids.
• Your periods have become heavy and painful and intercourse is painful on deep penetration. On examination a very tender thickened area can be felt at the top of the vagina highly suggestive of endometriosis.
• You have a history of past pelvic surgery and on examination the uterus feels fixed in position instead of being able to be easily moved, suggesting the presence of adhesions.
• You have had previous pregnancies with your partner ending in terminations. If you cannot now achieve a pregnancy with that partner, blocked fallopian tubes due to infection after the last termination may be the cause.
Main procedures to investigate infertility
The main surgical procedures that are used to investigate infertility are:
Examination under anaesthesia – a thorough internal examination of the pelvis to inspect the vagina and cervix and to assess the size, shape, position and mobility of your uterus and ovaries
Hysteroscopy – to inspect the cavity of the uterus to exclude any fibroids, adhesions or developmental malformation like a septum (wall dividing the cavity of the uterus), all of which may prevent implantation of a pregnancy.
Laparoscopy and dye test – to inspect the entire pelvis through a laparoscope, to confirm that the tubes are open and healthy and to exclude the presence of endometriosis and adhesions.
Your clinic may recommend further surgery if:
• your fallopian tubes are blocked
• you have fibroids, mild endometriosis or another condition that affects the uterus, tubes or ovaries
• you have polycystic ovary syndrome (PCOS) that has not responded to drug treatment
• you have been surgically sterilised and want to reverse the procedure.
How does the surgery work
Where keyhole surgery is used, the usual initial steps are:
Step 1. Under general anaesthetic, the doctor makes a small cut just at the lower edge of your navel.
Step 2. A telescope (called a laparoscope) is inserted to allow the surgeon to look at the affected areas.
Step 3. The next step then depends on the problem being treated.
Surgery for women – Common surgical procedures
There are a number of types of surgery that are fairly common procedures for treating various fertility problems.
Common surgical procedures
The following types of surgery are fairly common procedures for treating various fertility problems:
Unblocking the fallopian tubes
If you have only slight scarring or a reversible blockage of the tubes and your clinic has the expertise, a type of surgery (salpingostomy) may be offered.
This is where the blocked outer end of the tube is opened at laparoscopy or by an open abdominal operation.
If the ovaries are covered in fine adhesions from previous pelvic inflammation, eggs in the ovaries have no access to the open end of the fallopian tubes and a pregnancy is not possible.
At laparoscopy it may be possible to surgically remove all adhesions (salpingo-oophorolysis).
Treating polycystic ovary syndrome (PCOS)
PCOS can be treated with drugs or surgery. The advantage of having surgery is that it does not increase the risk of multiple births.
In this procedure (ovarian drilling), a heated needle (electrodiathermy) is used to destroy some of the extra follicles (the sacs in which eggs develop) which are producing an excess of male hormones.
Treating mild endometriosis
If at laparoscopy you are found to have a few tiny deposits of endometriosis in the ovaries and pelvic ligaments, these may be destroyed at the time with electrodiathermy.
If the endometriosis is more extensive, you may be offered further surgery where the endometriotic tissue is removed, usually through microsurgery or by laser surgery.
Removal of fibroids
It is possible to shrink large fibroids with drugs taken over a long period of time. However it is generally felt that significant fibroids thought to affect your fertility should be surgically removed. This can be achieved laparoscopically or by open surgery.
If you have had large fibroids removed, leaving several scars in the uterus, it will be recommended that when you become pregnant, the subsequent delivery of your baby should be by Caesarean Section.
Before considering a reversal of sterilisation, it would make sense to ensure that your partner’s semen analysis shows a normal sperm count. There would be little point in undergoing major surgery to subsequently find that your partner’s sperm count is zero
Sterilisation can be reversed where the procedure was achieved by:
• cutting and then tying the fallopian tubes
• by blocking the tubes by placing a small plastic clip or ring across them.
The reversal will depend upon the site of the sterilisation on each tube, and, in the case of cutting and tying the tubes, how much healthy tube remains.
If the sterilisation has been performed using electrodiathermy, usually the entire tube will have been destroyed and reversal is not possible.
If the sterilisation site is close to the junction of the tube to the uterus, and not much tube has been removed or destroyed, the successful delivery rate after reversal of sterilisation should be above 70%.
Microsurgical techniques are normally used to rejoin two sections of undamaged tube, enabling it to function normally again.