In many cases, the cause of difficulty in achieving a pregnancy can be treated surgically. The procedures performed as part of the investigation and treatment of infertility are, for the most part, minimally invasive—meaning they are carried out either through natural openings or through very small incisions in the woman’s abdomen. As a result, a woman’s day-to-day life is not significantly affected after surgery, there is no substantial delay in continuing efforts to conceive, and the cosmetic outcome is excellent.

The two main minimally invasive surgical methods used in the diagnosis and treatment of infertility are hysteroscopic surgery and laparoscopic surgery. In special cases, robotic-assisted laparoscopic surgery may be used, for example in cases of multiple large fibroids.

 

The hysteroscopy involves the insertion of a thin and long endoscope called a hysteroscope into the uterine cavity/the inside of the uterus. The hysteroscope is introduced through normal “openings”—the vulva, vagina and cervix—into the uterine cavity, in order to identify and treat pathological findings that may contribute to or cause infertility in the couple. The procedure is performed under sedation in a clinic.

 

In cases where no problem is detected during the initial infertility work-up, or when there have been unsuccessful IVF attempts, hysteroscopy is indicated as the test of choice for the accurate evaluation of the endometrium (diagnostic hysteroscopy).

Examples of pathology treated with hysteroscopy include:

Hysteroscopy is almost always a day-case procedure, meaning the woman will leave for home 2–3 hours after the end of the operation. Recovery is completed within 24 hours and the woman—if she wishes—can return to work the day after the procedure.

The findings and the procedure are recorded on a DVD and will be discussed later at the doctor’s office.

 

Laparoscopy is the surgical technique that allows operations to be carried out through small (5–12 mm) incisions in the woman’s abdominal wall. A thin and long camera usually enters through the navel into the abdominal cavity, and then 2–3 additional micro-instruments are inserted through these small openings.

The procedure is performed under general anaesthesia in a clinic.

With laparoscopic surgery we diagnose and also treat pathological conditions inside the woman’s abdomen that may contribute to infertility, or that, when treated, improve the success rates of an IVF attempt.

Examples of pathology treated laparoscopically and related to infertility include:

The laparoscopy is recorded on a DVD. The findings and the procedure are discussed at the doctor’s office during the postoperative follow-up.

The woman will return home the same day or the day after surgery, while depending on the procedure she will return to professional activity in 3–5 days.

Depending on the laparoscopic surgeon’s experience, laparoscopy allows the performance of fairly extensive gynaecological operations such as multiple myomectomy.

Depending on the operation performed, the woman will return to attempts to conceive within 1 to 8 months.

Dr D. Koleskas is specialised in minimally invasive surgery in gynaecology (Minimally Invasive Surgery, M.A.S.), has served as a Consultant leading the Laparoscopy and Hysteroscopy surgical team at the university hospital Royal Victoria Infirmary, Newcastle, United Kingdom, and has extensive experience in laparoscopies and operative hysteroscopies in infertility cases.