Fertility Surgery: Laparoscopy & Hysteroscopy

• Overview (jump to topic): Fertility surgery can help individuals or couples with infertility address several specific reproductive issues, most often affecting the woman.
• Procedures: We perform most surgeries for infertility using minimally invasive surgery, which involves incision-free (hysteroscopy) or small incisions (laparoscopy/robotic), resulting in quicker recovery time for the patient.
• Laparoscopy: This type of minimally invasive surgery uses small incisions in the abdomen to insert a laparoscope (a small fiber optic tube with a light and camera) to diagnose the issue and small surgical instruments to correct the problem.
• Hysteroscopy performs a similar function, but instead of using abdominal incisions, the hysteroscope is inserted through the cervix into the uterus to diagnose and treat issues. This is an in-office procedure with a relatively quick recovery for most patients.
• Risks: Like any surgical procedure, minimally invasive surgery poses risks of blood loss, blood clots, scar tissue and pain. More severe complications are rare.
• Our providers thoroughly discuss all of the risks/benefits and all aspects of the planned fertility surgery with the patient, answering all questions and addressing all concerns.

What are laparoscopy & hysteroscopy fertility surgeries?

The Fertility Institute physicians typically use minimally invasive surgeries to diagnose and treat conditions that may interfere with a woman’s ability to get or stay pregnant. For more complex surgical situations, we may use robotic surgery. The two most common surgeries performed for infertility are laparoscopy and hysteroscopy, both of which can diagnose a condition and treat it during the same surgical procedure.

When the situation does not lend itself to correction by these minimally invasive means, we use traditional open surgery, or laparotomy, that involves larger incisions.

Other physicians often send us their difficult fertility surgery cases. FINO, Louisiana’s first fertility clinic, has the experts you can trust.

Infertility issues or conditions diagnosed or treated with laparoscopy & hysteroscopy

• Abnormalities in the uterus or ovaries.
• Blocked fallopian tubes.
• Adhesions (scar tissue).
• Ectopic pregnancy.
• Ovarian cysts.
• Uterine fibroids.
• Endometriosis (can only be confirmed with laparoscopy).

Learn more about causes of infertility

Minimally invasive surgery and robotic surgery

Minimally invasive surgery is a surgical approach in which tiny incisions (less than an inch in size) and specialized tools are used to perform the surgery. It utilizes a scope that projects the interior images on an external monitor.

In comparison to “open” surgery that is performed with larger incisions, minimally invasive surgery means quicker procedures, less pain, shorter recovery times and decreased surgical risks. Laparoscopy (see below) is one of the first forms of minimally invasive surgery used.

We may use robotic surgery, which is an advanced form of minimally invasive surgery that is often better at addressing more complex surgeries. This is due to its greater precision and flexibility to do complex procedures in very tight places. The robotic tools can perform movements that the human hand can’t.

Robotic surgery uses a computer to control a robotic arm directed by the surgeon to perform the surgery.

It also gives the surgeon a 3D view on a monitor of the area of surgery.

Laparoscopy for infertility

Laparoscopy is both a diagnostic and surgical tool for use on women experiencing infertility. It involves the use of a laparoscope, a small fiber optic tube with a light and camera, and small surgical instruments inserted through tiny incisions in the abdomen.

These allow the fertility surgeon to easily diagnose and repair issues in the reproductive organs during the same surgical procedure. The surgeon will make two or more small incisions measuring about a quarter inch across. The first is typically made in the navel and the second in the lower abdomen.

Laparoscopy typically takes about 30-90 minutes to complete and is performed under general or local anesthesia. To achieve the best view of the organs, the abdominal cavity is inflated with gas to move organs away from the abdominal wall and provide extra room and visibility.

During the procedure, doctors may take tissue samples, drain cysts or fix additional structural issues, such as removing adhesions or fibroids. Once the surgery is complete, the gas is removed and the incisions are closed with absorbable stitches.

When is laparoscopy beneficial for fertility treatment?

Laparoscopic procedures are generally recommended for fertility issues only after all other reproductive imaging tests have not resulted in a diagnosis.

Laparoscopy may also be used to treat many conditions that contribute to infertility including fibroids, ovarian cysts and endometriosis.

Finer Points

What to expect when having laparoscopic surgery

• Patient must stop eating 12 hours prior to surgery.
• One hour before, the woman will also need to empty her bladder and will receive fluids and medications intravenously (IV) through a vein in the arm.
• In the operating room general anesthesia will be applied through the IV, and the patient will fall asleep.
• While prepping for surgery, a breathing tube and/or catheter may be placed. The pubic hair may be shaved.

Hysteroscopy for infertility

Hysteroscopy is performed to diagnose abnormalities that may affect a woman’s fertility or cause other gynecological issues. Hysteroscopy is a minimally invasive surgery that involves inserting the hysteroscope, a small tube with a light and camera, through the cervix and into the inflated uterus. This allows the doctor a more direct view of the uterus and fallopian tubes. No incisions are required.

While performing the hysteroscopy for making a diagnosis, the surgeon may decide to correct any conditions identified, turning a diagnostic hysteroscopy into an operative hysteroscopy. In this case, small surgical tools are then inserted through the hysteroscope to correct such problems as adhesions (scar tissue), fibroids and polyps.

Patients go home the same day as the procedure and can often return to work the next day.

When is hysteroscopy beneficial for fertility treatment?

A hysteroscopy procedure is used to diagnose causes of uterine abnormalities such as polyps or fibroids, many of which can cause infertility. Operative hysteroscopy can often then be used to treat these abnormalities.

A hysteroscopy is usually done after less invasive reproductive imaging techniques have failed to result in a diagnosis.

Finer Points

What to expect when having hysteroscopic surgery

• A hysteroscopy is performed using a sedative to make the woman more comfortable and relaxed during the procedure, or under general anesthesia.
• Prior to the hysteroscopy, the patient will empty her bladder and wear a hospital gown.
• The patient will lie face up on the exam table, with her feet supported in stirrups.
• The doctor will insert a speculum into the vagina for better visibility of the cervix.
• The doctor will guide the hysteroscope into the vagina, through the cervix and into the uterus, which will be inflated with liquid.
• After the procedure, the patient will be monitored for a couple of hours before going home. She should have someone drive her home.
• Hysteroscopic surgery should only be performed on women who are not pregnant and are not menstruating. Performing the hysteroscopy on days 6-14 (after menstruation but before ovulation) of the menstrual cycle can help to ensure the patient is not pregnant.

At The Fertility Institute of New Orleans, fertility treatment has helped many people achieve their family goals – with 19,000 pregnancies and counting.

Awake hysteroscopy procedure

Dr. Huber at the Metairie location is now offering office-based, awake hysteroscopy procedures. These differ from a traditional hysteroscopy, which sometimes uses general anesthesia, as there is no anesthesia and minimal discomfort. This type of hysteroscopy is convenient and extremely effective.

The procedure typically lasts 5-10 minutes from start to finish, but can sometimes be completed in less than 2 minutes depending on the pathology found. Recovery time is minimal, and most patients are able to continue with their life as normal shortly after the procedure. Full recovery is expected within 12-24 hours.

Good candidates for an awake hysteroscopy include:

• Patients in need of additional imaging for diagnostic purposes.
• Patients with suspected or known small intrauterine pathology like scar tissue, placental or fetal tissue in the uterus after pregnancy loss or delivery, small polyps, etc.

 Schedule an appointment with Dr. Huber for an awake hysteroscopy.

Fertility surgery risks and side effects

Like any surgery, those performed to address reproductive issues have innate risks. These are lessened when procedures are performed using minimally invasive surgery. Minor complications include infection and skin irritation at the incision.

In approximately 1%-2% of cases, more severe complications may occur and can include:

• Complications from anesthesia (vomiting, nausea, headache, allergic reaction, lung infection).
• Formation of scar tissue.
• Nerve damage.
• Excessive bleeding or formation of blood clots.
• Hematomas (a swelling caused by blood outside its vessel).

Though quite rare, there is a risk that surgical tools used may damage the uterus, abdominal wall or other organs. If this occurs, the damage will be repaired immediately.