Laparoscopy allows a healthcare provider see the abdominal organs and sometimes make repairs, without making a larger incision that can require a longer recovery time and hospital stay. Whether or not diagnostic laparoscopy should be done in people with infertility is controversial. Laparoscopic surgery to help diagnosis a cause for infertility is performed only after other infertility testing has been completed, or if symptoms warrant testing. Laparoscopy should not be done routinely, however. If a person is experiencing pelvic pain, then the consensus is that surgery may be recommended. However, in cases of unexplained infertility, or situations where pelvic pain is not a factor, whether the benefits of the surgery outweigh the risks is a matter of debate.
When Laparoscopy Is Used
Possible reasons your doctor may recommend diagnostic laparoscopy include:
You experience pain during sexual intercourse You have severe menstrual cramps or pelvic pain at other times in your cycle Moderate to severe endometriosis is suspected Pelvic inflammatory disease or severe pelvic adhesions are suspected Your doctor suspects an ectopic pregnancy (which can be life-threatening if left untreated)
Laparoscopic surgery may be used to surgically treat some causes of female infertility. Your doctor may recommend surgery if:
Hydrosalpinx is suspected. This is a specific kind of blocked fallopian tube. Removing the affected tube can improve IVF success rates. Endometrial deposits are suspected of reducing your fertility. This is rather controversial, with some doctors saying removal is only warranted if you’re in pain, and others saying it can improve pregnancy success rates and is worth doing even if pelvic pain isn’t a problem. Surgery may be able to unblock or repair a fallopian tube. Success rates vary greatly when it comes to tubal repair. If IVF is going to be required even after surgery, then going straight to IVF is a better choice. If the woman is young and all other fertility factors look good, surgical repair may be worth trying first. An ovarian cyst is suspected of causing pain or blocking the fallopian tubes. Sometimes, drainage of the cyst with an ultrasound-guided needle is better. Removal of a large endometrial ovarian cyst may reduce your ovarian reserves. Your doctor should discuss this with you. A fibroid is causing pain, distorting the uterine cavity, or blocking your fallopian tubes. You have PCOS and your doctor recommends ovarian drilling. Laparoscopic ovarian drilling involves making three to eight tiny punctures into the ovaries. In women with PCOS who have not ovulated on fertility drugs, this procedure may enable them to ovulate on their own. However, the risks may not outweigh the benefits, and its use is controversial.
Why It’s Needed
Some causes of infertility can only be diagnosed through laparoscopy. (Endometriosis, for example.) Laparoscopy allows your doctor to not only see what’s inside your abdomen but also biopsy suspicious growths or cysts. Also, laparoscopic surgery can treat some causes of infertility, allowing you a better chance at getting pregnant either naturally or with fertility treatments. Laparoscopy can be used to remove scar tissue, a fibroid, or endometrial deposits that are causing pain.
How Is It Done?
Laparoscopy is performed in a hospital under general anesthesia. While it is sometimes possible to conduct a diagnostic laparoscopy in a fertility clinic office, this is not recommended. In the office setting, if something is found during the procedure, you will need to have the procedure again in a hospital setting for the repair. Your doctor will give you instructions on how to prepare for surgery beforehand. You will probably be told not to eat or drink for 8 or more hours before your scheduled surgery, and you may be instructed to take antibiotics. When you get to the hospital, you’ll receive an IV, through which fluids and medication to help you relax will be delivered. The anesthesiologist will place a mask over your face, and after breathing a sweet-smelling gas for a few minutes, you’ll fall asleep. Once the anesthesia has taken effect, the doctor will make a small cut around your belly button. Through this cut, a needle will be used to fill your abdomen with carbon dioxide gas. This provides room for your doctor to see the organs and move the surgical instruments. Once your abdomen is filled with gas, the surgeon will then place the laparoscope through the cut to look around at your pelvic organs. The surgeon may also biopsy tissue for testing. The surgeon will visually evaluate the pelvic organs and the surrounding abdominal organs. He or she will look for the presence of cysts, fibroids, scar tissue or adhesions, and endometrial growths. He or she will also look at the shape, color, and size of the reproductive organs. A dye may be injected through the cervix, so the surgeon can evaluate if the fallopian tubes are open. Even if no signs of endometriosis or other problems are found, the surgeon may remove a sample of tissue to be tested. Sometimes, very mild endometriosis is microscopic and cannot be seen by the naked eye with the laparoscopic camera. If an ectopic pregnancy is suspected, the surgeon will evaluate the fallopian tubes for abnormal pregnancy.
How Will It Feel?
During laparoscopic surgery, you’ll be under the effects of general anesthesia, so you should not feel any pain, nor remember the procedure. When you wake up, you may have a sore throat. This is caused by the tube placed down your throat to help you breathe during surgery. (This tube is removed before you wake-up). It’s normal for the area around the cuts to feel sore, and your abdomen may feel tender, especially if your doctor removes a lot of scar tissue. You may feel bloated from the carbon dioxide gas, and you may experience sharp pains in your shoulder. This should go away in a few days. You may need a week or two to recover if many repairs were made. Be sure to speak to your doctor about what to expect. Your doctor may also prescribe pain medication and antibiotics. You should contact your doctor if immediately if…
You experience severe or worsening abdominal painYou develop a fever of 101 or higherThere is pus oozing or significant bleeding at the incision site
Risks
As with any surgical procedure, laparoscopy comes with risks. According to the American Society of Reproductive Medicine, one or two women out of every 100 may develop a complication, usually a minor one. Some common complications include:
bladder infection after surgeryskin irritation around the areas of incision
Other less common, but potential, risks include:
formation of adhesionshematomas of the abdominal wallinfection
Serious complications are rare, but include:
damage to the organs or blood vessels found in the abdomen (further surgery may be needed to repair any damage caused.)allergic reactionnerve damageurinary retentionblood clotsother general anesthesia complicationsdeath (around 3 in every 100,000)
If the Results Are Abnormal
Depending on what is wrong, the surgeon may treat the problem during the same surgery. Adhesions, endometrial growths, cysts, and fibroids may be removed in some cases. If the fallopian tubes are blocked, they may be opened, if possible. If an ectopic pregnancy is found, the surgeon will remove the abnormal pregnancy and repair any tissue damage. He may need to remove the entire fallopian tube.
Future Fertility
After surgery, your doctor will explain what your options are for getting pregnant. If you had fibroids removed or a fallopian tube repaired, you may be able to try to get pregnant without help. Also, in the case of endometriosis or PID, the removal of scar tissue may make it possible to get pregnant without further treatment. If after a few months after surgery you do not get pregnant on your own, your doctor may recommend fertility treatments.
