In women, anatomical abnormalities are a common cause of infertility. Rarely congenital, most structural damage to the reproductive organs is acquired and results from previous pelvic surgery, infection or endometriosis. Any of these conditions may cause scarring or closure of the fallopian tubes and thereby block the key passageway for conception.
The diagnosis of anatomical infertility is not always straightforward. Certain aspects of a woman’s history may suggest an anatomical blockage, but seldom is this revealed on physical exam. Most often, the diagnosis is determined on the basis of x-ray (hysterosalpingogram), sonohysterogram, diagnostic hysteroscopy and/or a laparoscopic evaluation. If confirmed, therapeutic modalities may include a variety of surgical procedures, including operative laparoscopy, operative hysteroscopy or microsurgical reconstruction via laparotomy.
Laparoscopic surgery is done through a thin, illuminated telescope that is placed through the abdominal wall. It may be simply diagnostic, as when it is used to confirm the normality of the pelvic structures, or therapeutic, as when it is used to correct internal pelvic problems. Laparoscopy can also be used to treat endometriosis and pelvic adhesive disease that may contribute to pelvic pain. Endoscopic video cameras and lasers enable experienced surgeons to perform even complicated reconstructive procedures on an outpatient basis. In many circumstances, laparoscopy may be done at the GENESIS on-site surgical suite.
Hysteroscopy is a procedure in which a thin telescope is placed, without incision, through the cervix in order to visualize the inside of the uterus. As with laparoscopy, hysteroscopy may be therapeutic as well as diagnostic. Procedures such as removal of fibroids or polyps, resection of scar tissue or a septum and opening of blocked tubes may be performed at the time of hysteroscopy. Diagnostic hysteroscopy is done at the GENESIS on-site surgical suite.
A small percentage of men produce no sperm in the ejaculate, a condition known as azoospermia. Obstructive azoospermia results from a blockage in the ducts that transport sperm from the testicles which may be congenital or acquired. Non-obstructive azoospermia is associated with severely diminished sperm production in the testicle. Specially trained urologists can retrieve sperm from these men by placing a needle in the testicle or epidydimis and aspirating sperm (Testicular Sperm Aspiration- TESA or Percutaneous Epidydimal Sperm Aspiration-PESA). A biopsy of the testicle can also be performed with a procedure called TESE (Testicular Sperm Extraction) or micro-TESE, which identifies the productive areas of the testicle through a microscope, so that a targeted biopsy can be taken. In many cases a single procedure will yield sufficient sperm to be used for the current IVF/ICSI procedure and also may result in enough sperm to be frozen for future use.
Although endoscopic surgery (ie- laparoscopy) has largely replaced the need for open abdominal surgery, occasionally the need does arise for such surgery, called laparotomy. Microsurgical reconstruction of the pelvis, in particular, requires laparotomy. In such cases, surgery is done through a specialized microscope that allows for magnification and meticulous dissection of the involved structures.
The physicians at GENESIS are all trained in the use of sophisticated surgical techniques. Surgery can be used to correct problems that partially or completely impair fertility and may also cause pelvic pain. Surgery alone may be sufficient to allow conception and pregnancy to occur. Depending on the nature of the underlying problem(s), additional medical therapy may be necessary to enhance the chances of successful pregnancy.
Should you require diagnostic or therapeutic surgery, the nurses, physician assistants and medical assistants you have come to know at GENESIS are the very same people who will care for you in our on-site operating and recovery rooms. Our medical personnel are sensitized to the particularly emotional and stressful circumstances surrounding your situation, and they will take the time to explain procedures to you. When entering the operating room for any procedure, it is normal to feel a certain amount of apprehension. Know that we are here to help you and truly care about your experience. We keep our OR a safe haven, a place where we begin the process of fulfilling your dreams. So, if you need to have surgery, be sure that we will provide this too with our very special “human touch.”