Several laparoscopic procedures are available to enhance fertility in couples looking to conceive. The term “enhance” is a broad term and includes diagnostic, stimulatory and therapeutic modalities.
Laparoscopy is the gold standard tool for patients with unexplained infertility (where all other causes of infertility have been ruled out). The prevalence of uterine abnormalities in patients prior to infertility treatment is 5.5%.
Several papers have shown that stimulation of endometrium during hysteroscopy (endometrial scratching) may have beneficial effects on implantation.
This involves exploring the fornix, vaginal canal and the cervix prior to performing a hysteroscopy.
Several conditions like endometriosis, vaginal septum, ectropion, scarring, inflammation, narrowing or obstruction to the cervical os can be corrected during a vaginoscopy.
Diagnostic Hystero Laparoscopy:
The commonest minimally invasive procedures performed for infertility workup due to its effectiveness in giving a conclusive diagnosis.Diagnostic hysterolaparoscopy is considered as effective as gonadotropins for clomiphene resistant Polycystic ovarian disease.
The whole procedure is done under general anaesthesia . A specialized instrument called the hysteroscope is introduced through the vagina to visualise inside the uterus .
A tiny incision is made at the belly button to visualize the uterus, fallopian tubes and ovaries. A dye is passed through the cervix to visualise the spill from the fallopian tubes.In situations where there is no spill , the fallopian tube is individually canalised.
Uterine Septal Resection:
A septum is a thick fibrous band present within the uterine cavity, dividing the uterus into two halves. Several first and second trimester abortions may occur due to the presence of a septum.This procedure has shown an 81% increase in pregnancy rate.A Resectoscope with a Collin’s knife is used to resect a uterine septum.
Hysteroscopic polypectomy :
Small polyps in the endometrium have shown to reduce pregnancy rate. Several studies have shown that after removing the polyp, the chances of pregnancy have increased three-fold.
An operative hysteroscope is passed into the uterus and the base of the polyp is dissected off with the scissors and retrieved outside using the grasper.
Fibroids are benign lesions on the uterus, that cause infertility among other issues.
Fibroids which are within the uterine cavity have found to be detrimental to implantation and growth of the fetus. A hysteroscopic or a laparoscopic myomectomy will help improving chances of a successful implantation and pregnancy.
Adenomyosis is a condition where the endometrial stroma (lining of the uterus) invades into the layers of the uterine musculature making it bulky. Adenomyosis is also associated with infertility among other things.
A laparoscopic adenomyotic resection requires coring out a focal area of highly concentrated adenomyosis in a wedge shape using a monopolar hook and approximating the cut surfaces.
Tubal re cannulation:
Some couples have a change of heart and plan to conceive another child , tubal re cannulation is a process of re-opening the fallopian tubes .This process requires specialized 3mm instruments and really thin (6.0) sutures.
Hydrosalphinx is a condition where the fallopian tubes are damaged and filled with fluid. A laparoscopic tubal clipping is done for these patients, this prevents the leakage of fluid into the uterine cavity and might improve implantation rates during an embryo transfer.
Laparoscopic Dermoid cyst excision:
Dermoid cysts are benign cystic teratomas (tumors) that cause infertility. These cysts are commonly present in reproductive age group women and their effective removal will improve chances of conception.
As fertility specialists, we are concerned about ovarian reserve, thus we make every effort possible to preserve as much ovarian tissue as possible.
A laparoscopic dermoid cyst enucleation is completed using needle holders and the ovary is then re approximated to restore it to its original configuration. Using a specialized endo-bag, the dermoid cyst is retrieved outside the body.
About 20.5% of patient population suffering from infertility have endometriosis. A correlation between endometriosis and infertility has not been properly established, but patients with visible endometriotic lesions showed better pregnancy rates after resection. ESHRE regards laparoscopic endometriotic resection as the gold standard treatment.
A laparoscopic endometriotic resection involves restoring the anatomy of the uterus to its original configuration. A chocolate cyst (endometriotic) will also be drained if present. In situations where there are high chances of recurrence, the cyst wall will be excised and the ovary will be re-sutured to avoid further cyst formation.
Poly Cystic Ovarian (PCOD) drilling:
Laparoscopic ovarian drilling will trigger ovulation in women with polycystic ovaries and resistant to ovulation medication. We individualize the number of punctures depending on the size of the ovaries, the patient’s history and several other factors.
Tiny punctures are drilled inside the ovary in efforts to restore natural ovulation.The ovaries are then compressed for effective hemostasis and to prevent adhesion formation.
Ectopic pregnancy is a condition where the pregnancy is formed in a location other than within the uterus (in most conditions within the fallopian tubes). Depending on the size, cardiac activity, rupture status the management differs.Medical management is tried for non-emergency ectopic cases.
A small ectopic mass which is present towards the fimbrial end (tip of the fallopian tube) the ectopic mass can be extruded out. Ectopic mass present towards the cornual end (towards the uterus) need to be excised.
Why choose Indigo Womens Center for your procedure?
Most hospitals offer either fertility treatment or laparoscopic treatments.We are one of the few centres where both fertility and endoscopic specialists are under one roof thus there is a coherence in treatment protocols and management. Our doctors being fertility specialists specialise in restoring the anatomy of the uterus to its original form.Our expertise lies in suturing, while most ob gyns do not make attempts to conserve the ovary, we make sure that we remove only the diseased part and re-suture the ovary back to its normal anatomic state.Our patient volume gives us enough experience to perform these surgical techniques without any complications.