After initial assessment, we may recommend surgery – either to investigate the cause of infertility for you or your partner, or to overcome problems that are making it difficult for you to conceive.
Female fertility surgery
Diagnostic laparoscopy and hysteroscopy
This test is an important part of many couples’ fertility evaluation – but it is usually one of the last tests to be done, as it is a more invasive procedure. If your history or other tests show an obvious need for IVF, we may advise deferring or not performing this investigation.
Laparoscopy takes place under general anaesthesia with small incisions made at or just below the navel and the pubic hairline. A laparoscope (a small diameter telescope) is passed through the incision, enabling us to view the ovaries, fallopian tubes, uterus and pelvic cavity for abnormalities. We can check that your tubes are open (tubal patency) by injecting dye through the uterus and observing it spill or not through the ends of the fallopian tubes.
Hysteroscopy uses another small diameter telescope, called a hysteroscope. This helps us see into the uterine cavity to check for growths, adhesions and abnormal anatomy.
Endometriosis treatment
If your fertility specialist suspects you to have endometriosis, he/she may recommend a laparoscopy to confirm this diagnosis. Treatment depends, in part, on the extent of the condition and any other symptoms that you may be suffering from. It may involve surgical removal of the endometriosis and associated scar tissue at the time of the laparoscopy, or hormonen treatment to suppress the menstrual cycle and inhibit the growth of endometriosis.
If treatment for endometriosis does not result in a successful pregnancy, IVF will often be an appropriate option. Your fertility specialist will advise you on the most appropriate combination of treatments.
Several of our fertility specialists have an interest in the treatment of endometriosis, including advanced laparoscopic skills for removing the disease.
Tubal surgery
If you have any tubal damage, we will usually diagnose this during the laparoscopy. If it is likely to affect the success of your IVF, your doctor may recommend tubal surgery before starting treatment.
In some cases, your doctor may recommend surgery to remove scar tissue (adhesiolysis) or to correct tubal damage (for example, tubal anastamosis). Some types of tubal surgery may be performed through the laparoscope (adhesiolysis, salpingolysis), while other procedures (such as tubal anastomosis) may require microsurgery (see below).
If tubal surgery does not result in a successful pregnancy – or where damage to the tubes and other pelvic organs is so severe as to make surgery unlikely to be successful – IVF will be the treatment option with the best chance of success.
Microsurgery
Microsurgery may be used for procedures such as the reversal of sterilisation (tubal anastomosis), the re-opening of blocked tubes (salpingostomy) and the removal of scar tissue around the uterus, tubes and ovaries (adhesiolysis).
Microsurgery involves specialised operative techniques, including the use of an operating microscope. Surgeons trained in microsurgery use these skills and techniques for the repair of very small structures or obstruction, in the fallopian tubes.
Male fertility surgery
Microsurgery
As with female surgery, male microsurgery involves specialised operative techniques, including the use of an operating microscope. Surgeons trained in microsurgery use these skills and techniques for the repair of very small structures, such as the tubes that carry sperm (the vas deferens).
Microsurgical procedures in men include the reversal of sterilisation (vasovasostomy or vasoepididymostomy) and sperm retrieval procedures.
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