Many women will have a surgical assessment of their reproductive organsperformed prior to considering IVF. This usually takes the form of aHysteroscopy (looking inside the womb) and a Laparoscopy (looking insidethe abdomen to visualise the womb, fallopian tubes and ovaries).Unfortunately the standard to which this assessment is performed varieswidely between gynaecologists.
Fertility surgery is usually performed using surgical techniques as a planned;, as women usually feel well enough to go home on the day of their surgery and make a very quick full recovery. Day stay; surgery is so effective because most of the causes of infertility that are found, are small blockages of the fallopian tubes, adhesions or endometriosis, or abnormalities in the womb such as polyps, small fibroids or a septum.
These anatomical or physical abnormalities can be rectified using advanced surgical techniques that leave minimal scar tissue. A surgical division of adhesions, opening up of blocked fallopian tubes or removal of a small fibroid can have a profound effect on fertility and lead to a successful outcome without the need for further IVF treatment.
All of our surgery is carried out at the world-renowned Portland Hospital, the only private hospital in the UK dedicated to the care of women and children.
Fertility surgery can be offered for a range of problems
Treatment of problems in the womb
Surgery on the Fallopian tubes
Treatment of Endometriosis
Infertility and Uterine Surgery
There are a number of ways in which problems in the womb may be the cause of infertility or reduced fertility. The most common of these are:
Developmental abnormalities (uterine septum)
Fibroids
Polyps
Intrauterine adhesions
Uterine septum
A uterine septum is a band of fibro-muscular tissue, which extends down the middle of the uterine cavity. It is the result an abnormality in the formation of the womb and is present from birth. Some uterine septae are small and do not affect fertilty. In other women they are large and may affect fertility or contribute towards miscarriage. If the patient has a history of infertility or miscarriage then the septum is probably best removed.
In order to keep the cavity of the womb open we normally leave a coil within the cavity of the womb at the end of the procedure.
Uterine fibroids
Many women have fibroids and these often dont affect fertility. They may cause problems if they are larger than 3cms, if they project into the cavity of the womb or if they compromise the fallopian tubes. They may be removed through the cervix or by laparoscopic or open surgery. Click here for more Info.
Uterine Polyps
These are small fleshy overgrowths of the lining of the womb. They may be small or quite large (3cms) and project into the cavity of the womb. The bigger they are the more likely that they will cause problems with fertility. As they sit within the cavity they may interfere with implantation of the fertilised embryo and as a result they may cause problems both with natural fertility and with IVF treatment.
Fortunately, they are easily removed at Hysteroscopy following which they are sent for histopathology to check that there is no other reason for concern.
Uterine adhesions
Adhesions with womb can occur after any damage to the lining of the womb. These typically occur after instrumentation of the womb for an incomplete miscarriage (ERPC) or after termination of pregnancy. They may also occur after a normal birth or a Caesarean section.
They are a significant cause for infertility in women who have had a previous pregnancy (secondary infertility). The adhesions may be thin and filmy (like a net curtain) and easy to divide. Unfortunately they may also be very thick and widespread in which case treatment may sadly not be so successful.
Surgery on the Fallopian tubes
The fallopian tubes may become scarred, caught up in adhesions or blocked and as a result women may be infertile or have reduced fertility. Tubal surgery was developed to overcome these problems. The surgery is usually carried out laparoscopically as the operating field is magnified, there is minimal tissue handling, the tissues do not dry out and very fine instruments and sutures may be used.
All of these surgical techniques are important in minimizing the trauma of the surgery, optimizing results and speeding up recovery. Tubal surgery is particularly useful in mild disease at the ovarian end of the tube or where the tube is blocked right next to the womb.
Unfortunately, not all tubal disease is amenable to surgery and if the damage to the tubes is severe then it is important to consider that success rates from IVF may be superior. However, if the tubal disease is severe then surgery may still be helpful as there is evidence that the presence of the damaged fallopian tubes may reduce success rates of IVF treatment. In these cases or where the tubes are blown up with fluid (hydrosalpinges) then the fallopian tubes are probably best removed or clipped.
Treatment of endometriosis
Endometriosis is found in around 35% of infertile couples. There are many treatment options for this but surgery is probably the best. The success of treatment is very dependent on the severity of the disease. However, endometriosis can be excised or ablated with an impressive doubling of pregnancy rates even in moderate disease. If the endometriosis has caused scarring then this can be divided and normal pelvic anatomy can be restored and if there are cysts present then these can be removed to improve success rates of IVF.
Chris Barnick is regarded as one of the best in London Gynaecology. He has delivered babies and performed gynaecological operations for more than 25 years.
A specialist Private Obstetrician at OBGYN Matters in central London he qualified at Guys Hospital in 1984. He has trained and worked ever since in top London teaching hospitals
