The following types of surgery are fairly common procedures for treating various fertility problems:
Unblocking the fallopian tubes
If you have only slight scarring or a reversible blockage of the tubes and your clinic has the expertise, a type of surgery (salpingostomy) may be offered.
This is where the blocked outer end of the tube is opened at laparoscopy or by an open abdominal operation.
If the ovaries are covered in fine adhesions from previous pelvic inflammation, eggs in the ovaries have no access to the open end of the fallopian tubes and a pregnancy is not possible.
At laparoscopy it may be possible to surgically remove all adhesions (salpingo-oophorolysis).
Treating polycystic ovary syndrome (PCOS)
PCOS can be treated with drugs or surgery. The advantage of having surgery is that it does not increase the risk of multiple births.
In this procedure (ovarian drilling), a heated needle (electrodiathermy) is used to destroy some of the extra follicles (the sacs in which eggs develop) which are producing an excess of male hormones.
Treating mild endometriosis
If at laparoscopy you are found to have a few tiny deposits of endometriosis in the ovaries and pelvic ligaments, these may be destroyed at the time with electrodiathermy.
If the endometriosis is more extensive, you may be offered further surgery where the endometriotic tissue is removed, usually through microsurgery or by laser surgery.
Removal of fibroids
It is possible to shrink large fibroids with drugs taken over a long period of time. However it is generally felt that significant fibroids thought to affect your fertility should be surgically removed. This can be achieved laparoscopically or by open surgery.
If you have had large fibroids removed, leaving several scars in the uterus, it will be recommended that when you become pregnant, the subsequent delivery of your baby should be by Caesarean Section.
Before considering a reversal of sterilisation, it would make sense to ensure that your partner’s semen analysis shows a normal sperm count. There would be little point in undergoing major surgery to subsequently find that your partner’s sperm count is zero
Sterilisation can be reversed where the procedure was achieved by:
- cutting and then tying the fallopian tubes
- by blocking the tubes by placing a small plastic clip or ring across them.
The reversal will depend upon the site of the sterilisation on each tube, and, in the case of cutting and tying the tubes, how much healthy tube remains.
If the sterilisation has been performed using electrodiathermy, usually the entire tube will have been destroyed and reversal is not possible.
If the sterilisation site is close to the junction of the tube to the uterus, and not much tube has been removed or destroyed, the successful delivery rate after reversal of sterilisation should be above 70%.
Microsurgical techniques are normally used to rejoin two sections of undamaged tube, enabling it to function normally again.