Laparoscopy for Surgical Infertility Testing and Treatment

Why It's Done, What Happens, and Expected Recovery Time

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After laparoscopic surgery for infertility, you'll likely go home the same day. Your doctor may prescribe pain medication or antibiotics. Steve Debenport / Getty Images

Laparoscopy may be used to diagnosis infertility or to treat a fertility problem. Laparoscopy is a surgical procedure that involves making one, two, or three very small cuts in the abdomen, through which the doctor inserts a laparoscope and specialized surgical instruments. A laparoscope is a thin, fiber-optic tube, fitted with a light and camera.

Laparoscopy allows your doctor to see the abdominal organs and sometimes make repairs, without making a larger incision that can require a longer recovery time and hospital stay.

Whether or not diagnostic laparoscopy should be done in women with infertility is controversial. If a woman is experiencing pelvic pain, then the consensus is that surgery may be recommended.

However, in cases of unexplained infertility, or situations where pelvic pain is not a factor, whether the benefits of the surgery outweigh the risks is a matter of debate.

When Is Laparoscopy Recommended During a Fertility Evaluation?

Your doctor may suggest laparoscopic surgery to help diagnosis a cause for infertility. Usually, it's performed only after other infertility testing has been completed, or if symptoms warrant testing.

Laparoscopy should not be done routinely, however.

Possible reasons your doctor may recommend diagnostic laparoscopy include:

When Is Laparoscopy Recommended During Fertility Treatment?

Often (but not always), if a diagnostic laparoscopy finds problems, the reproductive surgeon will repair, remove, or otherwise treat the issue right away.

Laparoscopic surgery may be used to surgically treat some causes of female infertility. Your doctor may recommend surgery if

  • Hydrosalpinx is suspected. This is a specific kind of blocked fallopian tube. Removing the affected tube can improve IVF success rates.
  • Endometrial deposits are suspected of reducing your fertility. This is rather controversial, with some doctors saying removal is only warranted if you’re in pain, and others saying it can improve pregnancy success rates and is worth doing even if pelvic pain isn’t a problem.
  • Surgery may be able to unblock or repair a fallopian tube. Success rates vary greatly when it comes to tubal repair. If IVF is going to be required even after surgery, then going straight to IVF is a better choice. If the woman is young and all other fertility factors look good, surgical repair may be worth trying first.
  • An ovarian cyst is suspected of causing pain or blocking the fallopian tubes. Sometimes, drainage of the cyst with an ultrasound-guided needle is better. Removal of a large endometrial ovarian cyst may reduce your ovarian reserves. Your doctor should discuss this with you.

Why Is Laparoscopy Important?

Some causes of infertility can only be diagnosed through laparoscopy. (Endometriosis, for example.) Laparoscopy allows your doctor to not only see what's inside your abdomen but also biopsy suspicious growths or cysts.

Also, laparoscopic surgery can treat some causes of infertility, allowing you a better chance at getting pregnant either naturally or with fertility treatments.

However, the most important reason for diagnostic laparoscopy is if you’re experiencing pelvic pain.

Laparoscopy can be used to remove scar tissue, a fibroid, or endometrial deposits that are causing pain.

How Is Laparoscopy Done?

Laparoscopy is performed in a hospital under general anesthesia. While it is sometimes possible to conduct a diagnostic laparoscopy in a fertility clinic office, this is not recommended. In the office setting, if something is found during the procedure, you will need to have the procedure again in a hospital setting for the repair.

Your doctor will give you instructions on how to prepare for surgery beforehand. You will probably be told not to eat or drink for 8 or more hours before your scheduled surgery, and you may be instructed to take antibiotics.

When you get to the hospital, you'll receive an IV, through which fluids and medication to help you relax will be delivered. The anesthesiologist will place a mask over your face, and after breathing a sweet smelling gas for a few minutes, you'll fall asleep.

Once the anesthesia has taken effect, the doctor will make a small cut around your belly button. Through this cut, a needle will be used to fill your abdomen with carbon dioxide gas. This provides room for your doctor to see the organs and move the surgical instruments.

Once your abdomen is filled with gas, the surgeon will then place the laparoscope through the cut to look around at your pelvic organs. The surgeon may also biopsy tissue for testing.

Sometimes two or three more small cuts are made so that other thin surgical instruments can be used to make repairs or move the organs around for a better view.

The surgeon will visually evaluate the pelvic organs and ​the surrounding abdominal organs. He or she will look for the presence of cysts, fibroids, scar tissue or adhesions, and endometrial growths. He or she will also look at the shape, color, and size of the reproductive organs.

A dye may be injected through the cervix, so the surgeon can evaluate if the fallopian tubes are open.

Even if no signs of endometriosis or other problems are found, the surgeon may remove a sample of tissue to be tested. Sometimes, very mild endometriosis is microscopic and cannot be seen by the naked eye with the laparoscopic camera.

If ectopic pregnancy is suspected, the surgeon will evaluate the fallopian tubes for an abnormal pregnancy.

How Will I Feel During Laparoscopy? What Will Be My Recovery Time?

During laparoscopic surgery, you'll be under the effects of general anesthesia, so you should not feel any pain, nor remember the procedure.

When you wake up, you may have a sore throat. This is caused by the tube placed down your throat to help you breath during surgery. (This tube is removed before you wake-up).

It's normal for the area around the cuts to feel sore, and your abdomen may feel tender, especially if your doctor removes a lot of scar tissue. You may feel bloated from the carbon dioxide gas, and you may experience sharp pains in your shoulder. This should go away in a few days.

Though you'll probably go home on the same day as your surgery, you should plan on taking it easy for at least one or two days. You may need a week or two to recover if many repairs were made. Be sure to speak to your doctor on what to expect.

Your doctor may also prescribe pain medication and antibiotics.

You should contact your doctor if immediately if…

  • You experience severe or worsening abdominal pain
  • You develop a fever of 101 or higher
  • There is pus oozing or significant bleeding at the incision site

What Are the Risks of Laparoscopy?

As with any surgical procedure, laparoscopy comes with risks.

According to the American Society of Reproductive Medicine, one or two women out of every 100 may develop a complication, usually a minor one.

Some common complications include:

  • bladder infection after surgery
  • skin irritation around the areas of incision

Other less common, but potential, risks include:

Serious complications are rare, but include:

  • damage to the organs or blood vessels found in the abdomen (further surgery may be needed to repair any damage caused.)
  • allergic reaction
  • nerve damage
  • urinary retention
  • blood clots
  • other general anesthesia complications
  • death (around 3 in every 100,000)

What Happens if the Results Are Abnormal?

Depending on what is wrong, the surgeon may treat the problem during the same surgery. Adhesions, endometrial growths, cysts, and fibroids may be removed in some cases.

If the fallopian tubes are blocked, they may be opened, if possible. If an ectopic pregnancy is found, the surgeon will remove the abnormal pregnancy and repair any tissue damage. He may need to remove the entire fallopian tube.

After surgery, your doctor will explain what your options are for getting pregnant. If you had fibroids removed or a fallopian tube repaired, you may be able to try to get pregnant without help.

Also, in the case of endometriosis or PID, the removal of scar tissue may make it possible to get pregnant without further treatment.

If after a few months after surgery you do not get pregnant on your own, your doctor may recommend fertility treatments.

Sources

Endometriosis and Infertility: Can Surgery Help? Patient Fact Sheet. American Society of Reproductive Medicine.

Kuohung, Wendy. Hornstein, Mark D. “Evaluation of Female Infertility.” UpToDate.com.

Laparoscopy and Hysteroscopy: A Guide for Patients. American Society of Reproductive Medicine.

Tulandi, Togas. “Reproductive Surgery for Female Infertility.

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