When couples seek help for infertility, they discover a wide array of available tests and treatments. While the thought of surgery can be frightening, reproductive surgery is one of the many options that we now have to help attain pregnancy.
How Can Surgery Help?
Sometimes, an anatomic problem prevents a couple from conceiving. Surgery can help fix the obstruction, whether it’s a scarred tube or an abnormally shaped uterine cavity. In men, varicoceles (varicose veins in the scrotum) can often be a problem. Men and women who have undergone sterilization (vasectomy or tubal ligation) may also undergo surgery to try to regain fertility.
Which Surgery Is Done For Which Problem?
Doctors may recommend a surgical treatment based on the patient, her fertility problem, and the method with which the surgeon is most comfortable. If the surgery goes smoothly, most fertility procedures can be done on an outpatient basis.
Endometriosis: For women who are suffering from endometriosis, surgery can be done to remove, or lessen, the amount of abnormal tissue in the pelvis. This can be done through:
- Laparoscopy: The surgeon makes a tiny incision at the belly button and places a fiber optic camera, allowing the doctor to visualize any scarring or abnormal tissue. Additional small incisions are made to introduce the instruments needed to perform the surgery.
- Mini-laparotomy: The surgeon makes an incision in the abdominal wall to be able to reach the affected areas. Mini-laparotomy is performed through a small incision located just above the pubic bone. The surgeon explores the pelvis and corrects the problem.
- Laparotomy: The surgeon makes a larger incision, either just above the pubic bone or from the belly button down to the pubic hair area. Laparotomy may be needed for very severe scarring of the pelvis, and is not an outpatient procedure.
Scarring, obstruction or damage from infection or other reasons: If there is scarring of the tubes, any of the above mentioned surgeries may be considered. Scarring or abnormalities within the uterus can also be treated surgically with hysteroscopy. In this procedure, the surgeon passes a tiny fiber optic camera through the cervix and into the uterus. This camera allows the surgeon to see the inside of the uterus. He or she can then repair scarring and remove polyps or fibroids that are immediately beneath the uterine lining. Some surgeons may also attempt to repair blocked tubes through hysteroscopy, by threading a camera into the fallopian tubes.
Fibroids (benign tumors of the uterine muscle): Fibroids can be removed by one of the following procedures.
- Colpotomy (rarely used) which involves an incision through the vagina or
Reversal of tubal ligation: For women who wish to reverse a previous sterilization, the surgeon may use laparoscopy or laparotomy with microsurgery.
For men who are infertile, the conditions that require surgery are more limited:
Varicocele repair (also referred to as varicose veins in the scrotum): The surgeon makes a small incision, ties off the varicose vein, and restores fertility. A new treatment is being studied which involves blocking blood flow to the affected veins. A tiny incision is made in the leg or neck of the patient where a catheter is inserted and the doctor then releases pellets to block blood flow to the varicose vein.
Reversal of vasectomy: This surgery needs to be performed by a surgeon experienced in microsurgery.
What Are The Risks Involved?
As with all surgeries, there are risks. Some patients have reactions to anesthesia, although these are quite rare. The procedure itself may cause bleeding, infection , or injury to other organs. If complications occur, patients may have to stay in the hospital for a few days.
Will My Insurance Cover These Surgeries?
Coverage for infertility treatment, whether surgical or medical, varies from state to state and from insurance plan to insurance plan. Before you have a procedure, ask your doctor’s office to confirm what portion, if any, of the procedure will be covered. Surgery to treat problems other than infertility, such as pelvic pain in a patient with endometriosis, may be covered, and the procedure may also help improve your fertility. Surgery to reverse a prior sterilization is generally not covered by insurance.
Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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