Your physician may recommend reproductive surgery as a possible approach to your particular problem. Surgery may be performed by laparoscopy (3-4 small incisions in the abdomen, with instruments and a lighted telescope inserted through those incisions), by laparotomy (larger incision), or by hysteroscopy (lighted telescope and instruments inserted through the cervix for intrauterine surgery).

Sometimes your doctor may recommend a combination of the above techniques. More surgery is being performed by laparoscopy and hysteroscopy today than in the past, but all approaches have merit, depending on the situation.

Laparoscopy

Laparoscopy is performed to cut adhesions (scar tissue) around the Fallopian tubes and ovaries that may have formed from past infection, from endometriosis, or from prior surgeries. In addition, surgery to repair Fallopian tubes is sometimes performed if the Fallopian tube is not badly damaged (fimbrioplasty). The laser is often employed at the time of laparoscopy for these procedures.

Endometriosis , if present, can be vaporized with the laser and improve symptoms of pelvic pain. Large collections of endometriosis on the ovary (endometriomas) can be excised to improve pain and increase the chances of pregnancy.

The most important goal is to remove endometriosis completely. As subspecialists in Reproductive Endocrinology and Infertility , physicians at UAB have training and experience beyond that of a general Ob/Gyn in the use of laparoscopy for difficult cases of endometriosis and pelvic adhesions.

Laparotomy

A larger incision in the abdomen may be necessary to remove large fibroids from the full thickness of the uterus, thus preserving the uterus (abdominal myomectomy). Laparotomy is also often chosen to reconnect the Fallopian tubes in women who have changed their minds about a prior tubal ligation (microsurgical tubal anastomosis). During tubal anastomosis, very fine stitches, similar in thickness to a piece of hair, are used to reconnect the Fallopian tubes under microscopic visualization. The success rate of tubal anastomosis is approximately 60-75%, depending on how much Fallopian tube is present to reconnect.

The microscope is always used by our group because it has been shown to increase success compared to surgery without microscopic visualization. Women who conceive after this procedure should be aware that their risk of ectopic pregnancy is greater than that of women who have not had tubal surgery; early pregnancy monitoring by blood tests for $hCG and ultrasound is recommended.

Hysteroscopy

Hysteroscopy is the procedure often recommended to remove fibroids or polyps inside the uterus that cause abnormal bleeding, particularly when fertility is desired. Sometimes, scar tissue inside the uterus from a past D&C is noted, and can be cut at the time of hysteroscopy. Some women may experience recurrent early pregnancy losses due to a septum in the uterus. This septum can be removed during hysteroscopy to reduce the chances of future pregnancy losses. Blockages of the Fallopian tubes that occur at the junction of the uterus can sometimes be opened at hysteroscopy. Advanced operative hysteroscopy is another skill that Reproductive Endocrinology subspecialists acquire during training.


Recommendations

Reproductive surgery is an option for many patients. Others may have Fallopian tubes that are so badly damaged that IVF may be a better choice. Many options and approaches will allow couples to choose the best option to increase their reproductive potential.