The Role of Surgery in Fertility Treatment

Dr Wong Pak Seng, Fertility Specialist, Consultant Obstetrician & Gynaecologist

What is reproductive surgery?

Reproductive surgery is the use of surgery in conditions related to infertility. In females, it can be performed as a diagnostic procedure to find out the cause of infertility when no apparent reasons are obvious.

However, reproductive corrective surgery is commonly performed to either treat infertility with the aim of restoring the anatomy as far as possible to return the reproductive organs to normal or near normal state; or to optimise the reproductive organs in the female pelvis for fertility treatment in order to ensure easy access to the ovaries by removing abnormal growth such as cysts or diseased tubes. Surgery also aims to improve the chance of implantation of the developing baby by improving the womb through removal of polyps or fibroids.fertility

In males, reproductive surgery is performed to treat the physical condition that causes abnormal semen such as swollen blood vessels (varicocele) or blocked tubes. In men who have no treatable conditions, semen maybe extracted directly from the testicles with surgery.

Types of Reproductive Surgery

Reproductive surgery can be divided to laparoscopic keyhole surgery or conventional open surgery.

Laparoscopic keyhole surgery – where tiny keyhole punctures are made on the tummy to visualise and perform the surgery – is now the mainstay of reproductive surgery. Its greatest advantage is the ability to magnify the views of the operating field, allowing the surgeon to operate precisely and therefore minimising scar tissues. In addition, the patient recovers quickly due to less pain and commonly goes home after several hours. Another form of keyhole surgery is the hysteroscopic surgery where a camera is inserted through the vagina to visualise the inside of the womb and perform corrective surgery.

Open surgery is usually performed when keyhole surgery is not possible or available. Open surgery tends to be more invasive and has a longer recovery time though it is sometimes unavoidable if the disease is in an advanced stage, or when a surgery is repeated.

The recovery time after keyhole surgery is about 2-3 days but the recovery time after an open surgery can be up to a month.

Conceiving after Surgery

In general, the chance of conception is doubled after the surgery. However, if there are other associated problems such as male factor infertility, the woman may need additional fertility treatment such as artificial insemination (IUI) or test tube baby treatment (IVF/ICSI) in order to conceive.

For surgery that does not involve cutting the womb, the couple can start trying soonest possible, usually when the woman feels ready, which can be as soon as the following week. However, if the surgery involves cutting into the womb, such as a deep fibroid removal, the woman is advised to rest for 4-6 months before trying again.

Most doctors would like to see the woman for a review after surgery before they try to conceive. For women who had corrective tubal surgery, they should see the doctor as soon as they get pregnant as they have a higher risk of ectopic pregnancy.

Certainly, if the woman is not able to conceive 4-6 months after surgery, they may want to consider moving on to other form of fertility treatment. The wrong thing to do is to leave things for couple of years as the surgical condition may recur.

The Journey to Conception Series is meant as a guide to help couples achieve their dream of starting a family. We hope to be your trusted companion in your journey by providing pertinent answers to your burning questions about conception and fertility. The series is meant as a guide only and cannot replace medical attention. Please see a fertility specialist to get yourself and your spouse evaluated for an accurate diagnose and treatment.

 

The content, opinions and views expressed in this scientific material are entirely those of the author and are in no way influenced by Merck Serono.

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