Seeing a minimally invasive GYN specialist before you begin IVF treatments can help improve success rates of conceiving and carrying to term. The advanced trained surgical specialists at The Center for Innovative GYN Care have designed minimally invasive procedures to diagnose & treat possible causes of infertility, with the shortest recovery time, to help you start your family sooner.
Infertility is generally defined as the inability to conceive after one year of unprotected intercourse, or after six months in women over age 35. Forty percent of cases of infertility are due to male factors such as low sperm count, malformed sperm, or poor sperm motility. Forty percent of cases are due to female factors such as blocked fallopian tubes, abnormalities with the uterus or cervix, or problems with ovulation or eggs. In 20 percent of cases, no cause can be found. There are multiple causes of infertility and a full discussion on this broad topic is beyond the scope of this website. We will focus here on conditions that can be evaluated or treated surgically.
Polyps are excess growths of the lining of the uterus, or endometrium. It is thought that polyps cause infertility by disrupting the lining of the uterus, thus interfering with implantation of a fertilized embryo. One study showed that pregnancy rates among women who had their polyps removed were 63 percent, as compared to 28 percent among women who did not. Miscarriage rates are also higher among women with uterine polyps
Fibroids, or leiomyomas, are benign tumors of the uterine wall. They are very common, affecting over 80 percent of all women. Fibroids can vary greatly in size and quantity. They can distort the size of the uterus as well as distort the inner lining. Fibroids that push into the uterine cavity (submucosal fibroids) are especially associated with lower implantation rates, lower pregnancy rates, and increased rates of miscarriage.
To read more about fibroids, click here.
A uterine septum is a type of congenital malformation where the uterine cavity has a wedge-like wall at the top of the uterus, which protrudes into uterine cavity. Women with a uterine septum are at a significantly higher risk for miscarriage and infertility. It is thought that the septum is a poor environment for an embryo to implant in because of the poor vascular supply. If an embryo is able to successfully implant, the septum is unable to support the growing embryo with adequate blood supply and nutrients, resulting in early pregnancy loss. Presence of a uterine septum is associated with a 25 percent miscarriage rate.
A hydrosalpinx is a fluid-filled fallopian tube that can cause infertility. This occurs when the tube is blocked at the end. Inflammatory fluid accumulates within the tube, causing it to be dilated. It is thought that the inflammatory fluid can flow into the uterus, causing a hostile environment for an embryo and decreased implantation rates. [2-3] Presence of a hydrosalpinx was associated with a 50 percent lower success rate among women undergoing IVF. [4-5] A normal tube will push an embryo toward the uterus but a hydrosalpinx has abnormal flow. This increases the chance for the embryo to implant there, resulting in an ectopic pregnancy.
Endometriosis is the presence of endometrial tissue (the lining of the inside of the uterus) in a location outside of the uterus. Endometriosis causes infertility in a variety of ways. Endometriosis is associated with the release of excess inflammatory cells, resulting in pain and sometimes adhesions. It is thought that the inflammatory fluid can cause infertility by impairing sperm function as well as tubal function.[6-7] Endometriosis in the ovaries can cause formation of endometriomas, disrupting ovarian function. Severe endometriosis can cause pelvic adhesions, preventing conception.
Learn more about minimally invasive endometriosis resection.
Pelvic adhesions are the adhesions of structures within the pelvis and can vary widely in severity. They can simply be two structures adherent to one another, or they can be bands of adhesions between two structures. They can result from prior surgery, pelvic infection (such as pelvic inflammatory disease), or endometriosis. Adhesions surrounding the ovary may impair the ability of an egg to reach the tube after ovulation. Adhesions of the tube can prevent the sperm from reaching the egg, or an embryo from reaching the uterus.
Intrauterine adhesions are usually the result of uterine trauma or infection. Risk factors include having had any uterine procedure (such as dilation and curettage (D&C), myomectomy, cesarean delivery) or pelvic infection. Intrauterine adhesions can cause infertility by obstructing the tubal openings (preventing conception) or by disrupting the uterine lining (preventing implantation). Sixty-three percent of women with intrauterine adhesions have some degree of infertility.
- Human Reproduction Journal, 2005
- Human Reproduction Journal, 1997
- Human Reproduction Journal, 2000
- Fertility and Sterility Journal, 1998
- Human Reproduction Journal, 1999
- Fertility and Sterility Journal, 2008
- Fertility and Sterility Journal, 1996
Symptoms can vary widely depending upon the condition. Some women will have no symptoms at all, and the condition might only be discovered during an evaluation for infertility. Polyps and fibroids can cause irregular or heavy menstrual bleeding. Endometriosis can cause very painful periods, pelvic pain, pain with intercourse, pain with bowel movements, and low back pain. Intrauterine adhesions may sometimes cause abnormally light periods or even complete absence of periods, a condition known as Asherman’s Syndrome.
Imaging tests such as a pelvic ultrasound, MRI, sonohysterogram, or hysterosalpingogram (HSG) can raise suspicions of polyps, fibroids, septum, or abnormal tubes. A hysterosalpingogram can evaluate whether the tubes are open and assess their overall shape. Pelvic adhesions and endometriosis cannot be seen on imaging tests. For a definitive diagnosis, the abnormalities must be seen directly with a camera.
Hysteroscopy is the insertion of a small, thin, telescope-like camera into the uterus. A hysteroscopy is used to identify and treat uterine polyps, fibroids, and septum.
Laparoscopy is the insertion of a small, thin, telescope-like camera into the abdomen, usually through the navel. This allows for a full evaluation of the pelvis, including the uterus, tubes, and ovaries. Endometriosis, pelvic adhesions, and hydrosalpinx would all be seen through the laparoscope. To evaluate whether the tubes are open, dye can be injected through the cervix into the uterus in a procedure called chromopertubation. The tubes are confirmed to be open if the dye is seen to spill out of the tubes.
Management of the conditions discussed can be accomplished hysteroscopically, laparoscopically, or through a combination of both.
Uterine polyps, submucosal fibroids, intrauterine adhesions, and uterine septum can be removed hysteroscopically. Hysteroscopic procedures do not require any incisions, and most women are able to return to work the following day. Polyps and fibroids can be resected using a resectoscope. Filmy or mild intrauterine adhesions can be cut with hysteroscopic scissors. Extremely dense adhesions are removed using a resectoscope, often with the assistance of a laparoscope to avoid perforation of the uterus. Intrauterine adhesions can be prevented by using good surgical techniques, minimizing trauma to the uterus and uterine lining, and prevention of infection. Following an extensive uterine surgery or resection of intrauterine adhesions, an intrauterine balloon can be placed inside the uterus for approximately seven days to help further prevent adhesion formation. This keeps the walls within the uterus from touching each other as they heal, thus preventing them from adhering to each other. High -dose estrogen can also be given at the same time to help the endometrium to proliferate and cover the healing endometrium, which also prevents adhesion formation. This is usually taken for four weeks, after which time seven to 10 days’ worth of progesterone is taken to induce a period. A second look inside the uterus with the hysteroscope is usually conducted one to two months afterwards. Severe adhesions may require several rounds of this protocol.
Dilated or abnormal tubes can be evaluated at the time of laparoscopy. Sometimes adhesions can be removed to help open the tubes. Treatment of pelvic adhesions has been shown to improve pregnancy rates by restoring normal anatomic locations of the pelvic organs and removing barriers to conception. Hydrosalpinges can be removed laparoscopically and is the treatment of choice for women who will undergo IVF.
Endometriosis can be treated laparoscopically, preferably by excision of the implants. Some doctors will perform ablations, but that is a short term solution with little to no benefit. There are poor short and long term results, including increased pain after surgery, and is completely ineffective for adenomyosis.
EFFECTIVENESS OF TREATMENT
Although one small study did not show any difference in pregnancy outcomes after treatment of endometriosis, a much larger Canadian study showed significantly increased pregnancy rates after treatment, even among women with mild endometriosis. Women who had their endometriosis treated had a pregnancy rate of 31 percent versus only 18 percent in the untreated group. Multiple studies have shown that management of endometriosis with hormones can help improve pain but does not improve pregnancy rates.
WHY CIGC FOR MY INFERTILITY SURGERY?
Finding out that you are infertile can raise a lot of questions, and CIGC wants to give you the answers. Causes of infertility include anything from uterine polyps to uterine septum, as well as endometriosis. Choosing the best minimally invasive infertility surgeon to treat your condition is essential to a faster recovery. CIGC minimally invasive GYN procedures are designed to diagnose your situation and help you start your family with as little recovery period as possible.
Why not my OB/GYN?
It might be your first instinct to get treated by your OB/GYN when you first find out that you are infertile. A lot of patients have strong relationships with their OB/GYNs and do not think to “shop around” when it comes to diagnosing the cause for–and treating–their infertility. However, diagnosing the cause of infertility often requires a surgical procedure when imaging tests don’t provide all the answers. Since OB/GYNs are generalists, not specialists, they are not trained or experienced with minimally invasive technology. Many OB/GYNs are only trained in performing open or robotic procedures, which are more painful, more expensive, and higher-risk. CIGC, however, is a leader in the field of minimally invasive infertility surgery. Our powerful and unique technologies allow our surgeons to identify all of the anatomy during the surgery with only tiny incisions. Some of our our procedures are so non-invasive that many patients are able to return to work the next day.
We work in partnership with OB/GYNs
Your OB/GYN focuses on Obstetrics care. We focus on GYN surgery. It is always better to have an infertility treatment from a specialist. We have experience with all types of infertility cases, for both diagnosis and treatment. Most importantly, we have specialty training in laparoscopic surgery. Hysteroscopic and laparoscopic procedures are the most effective ways to diagnose and treat uterine polyps, fibroids, septum, endometriosis, pelvic adhesions, and hydrosalpinx – all the main causes of infertility. We are board-certified and fellowship-trained on such procedures.
If you want your procedure to involve expert surgeons, low complications, tiny incisions, and a fast recovery, visit CIGC.
As a patient, we urge you to find peace of mind in the form of the expertise and care of our surgical experts. Our physicians will help you fully understand your infertility as well as your treatment options. We promise to employ only the most effective and least invasive surgical techniques to facilitate a swift recovery.
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