Surgical Solutions prior to In Vitro Fertilisation

Hysteroscopy Resolves Uterine Issues

Operative hysteroscopy, which is used to treat uterine conditions, is a method applied under general anaesthesia. It is performed by inserting a hysteroscope with optical fibres into the uterine cavity through the uterine channel. In case any anatomical issue is established in the uterus (such as a septum, deformation), a change is made in the size of the uterine cavity.

This is the way to overcome any issues related to the positioning thereof, which affect adversely embryo implantation. The existence of a polyp or leiomyoma that stands out in the uterus, a previous infection or a surgical intervention (such as abortion) in the uterus, or areas of adhesion, may also pose pregnancy issues. All of those problems may be solved with the aid of hysteroscopy. Thus, the chances of getting pregnant increase. This method is not suitable for women with a double uterus. But if the uterus is septate or T-shaped, hysteroscopy will be able to open it. This will increase the chances of getting pregnant and will reduce the risk of a miscarriage or premature birth. Where the attempts at in vitro fertilisation repeatedly fail, diagnostic hysteroscopy may be performed to identify any problems that may be undetectable with an ultrasound test or hysterosalpingography.

Does laparoscopy increase the chances of getting pregnant?

As is well known, another major finding that accounts for uterine deformation and dysfunction, are leiomyomas. One out of every four women has a leiomyoma. Naturally, not every leiomyoma requires surgery. A leiomyoma does not have to be surgically removed, if it is no hindrance to getting pregnant. But leiomyomas may be removed surgically, provided that they engage the uterine cavity and present in a structure that would interfere with the blood flow to the internal uterine tissue, or if they are larger than 4 cm. It is the surgeon’s decision whether to perform the procedure using laparoscopy or open surgery. Any type of surgery will require to wait for at least 3 months before trying to conceive.

Laparoscopy is a closed surgical method. It is applied through small incisions in the abdomen, and is the preferred method in case of Fallopian tube issues. Such an issue is the collection of fluids in the Fallopian tubes as a result of blockages or structural abnormalities. With time the collected fluid may cause inflammation and get discharged in the uterus. This is a factor that reduces embryo adhesion and disrupts the healthy environment of the uterine mucosa. Thanks to laparoscopy, it is possible to remove the Fallopian tube that is of no use to, or even serves to hinder getting pregnant. This may increase the chances of getting pregnant by two and a half times.

When should endometrial cysts be removed?

Surgical procedures are also applied successfully to address ovarian issues. Many ovarian cysts may be removed with laparoscopy. The case of endometrial cysts, however, is slightly different. Those cysts affect adversely the formation and quality of ova. Therefore, those cysts should be very well examined in women who want to have children, and the decision to proceed with surgery should only be taken when all related risks have been considered. These cysts may be removed with laparoscopy if the patient has a good ovarian reserve, is young and the infertility period is short. Nonetheless, despite the foregoing, it is possible to succeed if you do in vitro fertilisation first. Bilateral or formerly treated endometrial cysts should be avoided. But in case of suspected cancer or cysts that block the access to the ovaries during in vitro fertilisation, laparoscopy may be opted for to remove the cysts. One should always bear in mind, though, that with surgeries there is always the risk of causing a certain reduction of the ovarian reserve. Although after surgeries couples are advised to try to conceive naturally for a year, if there is no pregnancy at the end of that period, in vitro procedures should commence.