Laparoscopy is a procedure where a camera is used to find out the internal condition of a patient’s abdominal organs. In addition, it allows the doctor to also perform repairs with in the abdomen if needed, without making a larger incision. In situations where infertility is the major reason to perform this procedure, laparoscopy can be used to diagnose infertility as well as treat it.
Laparoscopy is a surgical procedure that involves insertion of a laparoscope and other surgical instruments, through small incisions in the abdomen. One, two or three small incisions are made in the abdomen for laparoscope insertion, laparoscope is a thin fiber optic tube that is fitted with a camera and light.
Whether or not laparoscopy should be advised is a difficult decision to make when it comes to infertility patients. Some doctors are in favor however some feel otherwise.
Laparoscopy would be advised in the following conditions:
It is usually advised when other infertility testing have not helped in reaching a diagnosis for infertility, or if the symptoms point us towards this procedure.
- If a patient experiences severe pelvic pain at any time
- When there is a suspicion of pelvic inflammatory disease or infection
- If you experience severe menstrual cramps
- If the surgeon or doctor is suspecting endometriosis
- When your doctor is suspecting ectopic pregnancy, it needs to be ruled out immediately or it can be life threatening
- If you experience Dyspareunia; pain during intercourse
- When pelvic adhesions are suspected
Occasionally, during diagnostic laparoscopy, if your surgeon finds an abnormality that needs fixing then he/she may remove, repair or treat the problem right away.
Along with diagnostic purposes, laparoscopy is also performed for surgical purpose, following are the conditions where your surgeon might use the surgical approach of this procedure;
- Fallopian tube blockage, a blocked fallopian tube is a common cause for infertility in a lot of patients, this can be fixed laparoscopically by either repairing the tube or unblocking it. Your surgeon will make this call depending on your case, if you are young and tubal blockade is the only problem then this tubal repair may help you in conceiving naturally, however if due to any reason your only option is IVF (In Vitro Fertilization) then going straight to IVF and skipping laparoscopy is a better choice.
- If Hydrosalpinx is suspected, hyrdosalpinx is a condition where the fallopian tubes are blocked due to infection or ay kind of fluid buildup. Either a small part could be repaired or removed or an entire tube can be removed depending on the extent of tubal damage and or tubal blockage.
- Endometriosis deposits, these deposits are believed to cause infertility because they lead to an inflammatory reaction which causes scar tissues and adhesions along with pain. Some surgeons believe that removing these deposits laparoscopically may improve success rates for pregnancy, others however do not agree and hence this is controversial.
- Fibroids that cause pain, fibroids are muscular wall tumours present in the uterus. These may contribute to infertility by blocking the fallopian tubes or distorting the uterine cavity, they vary from small, seed-sized tumors to larger, grapefruit-sized tumours. Hence in some cases removing a fibroid may help the infertile couple.
- Ovarian drilling, another commonly done procedure using laparoscopy is ovarian drilling, its mostly done in patients suffering from polycystic ovarian syndrome who may benefit from ovarian drilling. This procedure involves making small punctures in the ovary, laparoscopically. The number of punctures may vary from 3 to 8, this helps women with PCOS to ovulate on their own when ovulation induction through fertility drugs have failed.
- An ovarian cyst, like a fibroid an ovarian cyst may also cause blockage of the fallopian tube and causes pain. The cyst can be removed laparoscopically giving higher chances of pregnancy once the blockage caused by an ovarian cyst is removed. However, care must be taken when removing an ovarian cyst, if a large cyst is removed it may cause a decrease in ovarian reserve, at times it is better to get this cyst removed by an ultrasound guided needle aspiration. Make sure you discuss it with your doctor.
Importance of laparoscopy in infertility:
A laparoscopic procedure allows your surgeon to not only diagnose the cause of infertility, by looking what’s inside the abdomen but also helps to biopsy any suspicious cyst or growths.
As discussed earlier, laparoscopy can be performed to remove any scar tissue, fibroids, ovarian cysts and endometrial deposits along with other surgical treatments performed laparoscopically. All these contribute to help one get pregnant naturally or through fertility medications.
After laparoscopy, your surgeon will suggest you appropriate options depending on the findings of the procedure. This varies from patient to patient, for example if your tubes were repaired or a fibroid was removed then you may be able to get pregnant naturally. Of course your surgeon would be the best person to lay down the options for you since he would have had seen the condition inside your abdomen himself.
By- Dr. Alvina Arslan Meer
ART Coordinator (MBBS) and Online Counselor