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- What is Infertility?
Infertility can be defined as the inability of a couple to achieve conception after a year or more of regular, unprotected intercourse.
- What are the most common causes of infertility?
The most common causes of female infertility are ovulatory disorders and anatomical abnormalities such as damaged fallopian tubes. Less frequent causes include, for example, endometriosis and hormonal disturbances like hypothyroidism, hyperprolactinimia, PCOD etc. Causes of male infertility can be divided into three main categories: Sperm production disorders affecting the quality and/or the quantity of sperm; anatomical obstructions & immunological & endocrine problems.
- My husband and I have an active sex life, we are both healthy, and my periods are regular. Why are we still unable to conceive?
You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your hormone tests are normal, husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving.
- Is infertility exclusively a female problem?
No. The incidence of infertility in women is 30-40% and exclusively a male problem in 20-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%).
- How can I determine my fertile period?
Your fertile period is the time during which having sex could lead to a pregnancy. This is the 4 days prior & 2 days after ovulation (release of a mature egg from the ovary). Women normally ovulate 14 days prior to the date of the next menstrual period.
- What is the general workup for infertility?
A variety of procedures can be used to diagnose the cause of infertility in a couple; these range from simple blood tests & hormone tests like Serum Prolactin, TSH, DHEAS, Testosterone in female & semen analysis in male partner. A transvaginal sonography & ultrasound follicular study can diagnose uterine anomalies, adnexal pathology like ovarian cyst, ovulatory dysfunction etc. Hysteroscopy & Laparoscopy can be done later for diagnosing uterine septum,intrauterine adhesions, tubal patency, endometriosis etc. An endometrial biopsy can be taken for Tb-PCR to rule out tuberculosis which is very common in India.
- Do painful periods cause infertility?
Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis.
- My periods are delayed. Could this be a reason for my infertility?
As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are ‘fertile’ in a year is decreased. Many patients with endocrine disorders like hypothyroidism, hyperandrogenism, PCOD etc have delayed periods so you should be investigated for that.
- Could blood group 'incompatibility' be a reason for our infertility?
There is no relation between blood groups and fertility.
- What treatment options do infertile couples have?
Several options are offered to couples depending on the type of infertility that has been diagnosed. The vast majority of female patients are successfully treated with ovulation induction drugs like clomiphene citrate, letrozole or gonadotropins.This may be combined with IUI. Patients with many cycles IUI failed or with blocked fallopian tubes may need IVF . In patients with severe male factor infertility like oligospermia or azoospermia or with failed fertilization may be benefited by ICSI. Elderly patients may recquire donor egg or donor embryo treatment.
- How many cycles of ovulation induction with clomiphene citrate or letrozole can be tried?
A maximum of 6 to 7 cycles can be tried with these drugs after which the treatment modality should be changed by either adding gonadotropin injections for ovulation induction or switching over to IVF or ICSI treatment.
- Can ovulation induction increase the risk of ovarian cancer?
Ovarian cancer is a rare disease; the chance of a young woman developing an ovarian malignancy during her lifetime is lower than 1.5%. A number of factors have been found to increase the risk of ovarian cancer, including genetic predisposition and dietary habits and infertility itself is a risk factor for ovarian cancer. There is evidence that each pregnancy reduces the risk of a woman contracting ovarian cancer . No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer.
- How successful is infertility treatment?
The average chance to conceive for a normally fertile couple having regular unprotected intercourse is around 25% during each menstrual cycle. It is estimated that 10% of normally fertile couples fail to conceive within their first year of attempt and 5% after two years. Each IUI cycle has 10 to 20 % chance per attempt depending upon the cause of infertility.IVF & ICSI cycles have 40 to50% chance per attempt.Donor egg & donor embryo treatment have 50 to 60% chance per attempt irrespective of the age.
- Are there particular factors influencing the success of a treatment?
In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman , cause of infertility, and the duration of the couple's infertility are likely to influence the success of treatment. In women, fecundity decreases as age increases, particularly after 40 years of age. Women with poor or damaged endometrium due to any infection specially tuberculosis have poor chance of implantation.In a couple with both partners having decreased fertility, the problem increases many fold.
- After having sex, most of the semen leaks out of my vagina. Could this be a reason for our infertility?
Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, enough sperm will reach the cervical mucus.
- My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal. Is that true?
Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.
- My husband's sperm count varies every time we test it. Is this possible?
Even a normal (fertile) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications.
- I have no problems having sex. So is my sperm count normal?
There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.
- My semen analysis report shows I have no sperm in the semen (azoospermia). Is this because I used to masturbate excessively as a boy?
Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. Sperms are constantly being produced in the testes.
- Is infertility a hereditary problem?
Most infertility problems are not hereditary, and you need a complete evaluation.
- Should I have intercourse every day to achieve pregnancy?
Sperms remain alive and active in woman's cervical mucus for 48-72 hours following sexual intercourse; therefore, it isn't necessary to have intercourse every day.
- Does stress play any role in infertility?
During treatment and before a pregnancy is achieved, feelings of frustration or loss of control is experienced by the infertile couple . Stress causes disturbances in the hormones secreted by brain & aggravates the problem. Patients who are stressfree conceive faster.
- What is IUI?
IUI is the direct placement of processed, highly motile, concentrated sperms washed free of seminal plasma and other cells into the uterine cavity.
- What are indications of IUI with husband’s semen?
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Ejaculatory failure
Anatomical
Neurological
Retrograde ejaculate
Psychological
- Cervical factor
Cervical mucus hostility
Poor cervical mucus
- Male subfertility
Hypospermia
Oligo/astheno/teratozoospermia
- Immunological
Male antisperm antibodies
Female antisperm antibodies
- Unexplained infertility
- Endometriosis
Mild
Moderate
- Ovulatory dysfunction
- Combined non-tubal infertility factors
- Poor response to superovulation in IVF cycle provided tubes are normal
- Cryopreserved husband’s semen
- What are indications of IUI with donor semen?
- Gross male subfertility
Azoospermia(CBAVD)
Severe oligozoospermia
Severe asthenozoospermia
Severe teratozoospermia
Oligo/astheno/teratozoospermia
- Genetic diseases, eg:hemophilia
- severe rhesus incompatibility
For many of these indications ICSI can be an alternative if cost is not an issue. Similarly PGD can detect healthy embryos in cases of genetic diseases.
- What is the success rate of IUI?
This depends on various factors. On an average success with IUI ranges between10 to 30 %. Cumulative pregnancy after about 4 IUI cycles will reach somewhere near 50%.
Factor affecting success rate of IUI are
- Age of both partners
- Cause of infertility
- Duration of infertility
- Sperm parameter / processing techniques
- Ovarian stimulation
- What is IVF?
In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed.
- What are the indications for IVF?
There are a variety of indications for IVF. Among these are:
Absent or Damaged Fallopian Tubes
Endometriosis
Unexplained Infertility
Recurrent Intrauterine Insemination Failure
Tubal and Pelvic Adhesions
Sperms antibodies in wife's and /or husband's serum
Male Factor Infertility
Age-Related Infertility
IVF also helps women who have absent ovaries or where there are no eggs in the ovaries
Preimplantation Genetic Diagnosis (PGD)
- What are preliminary investigations done before undergoing IVF or ICSI?
The Preliminary Investigations are:-
For Wife :-
1) Hysteroscopy & measurement of uterocervical length.
2) Ultrasound Examination of uterus and ovaries
3) Hormonal Profile (TSH, Prolactin, DHEAS,Testosterone,FSH & LH on 3rd day of the period).
4) Color Doppler for endometrial blood flow in some patients.
5) Routine tests like CBC, FBS, Blood VDRL, HBs Ag, HIV, Blood group Rh factor
For Husband :-
1) Semen analysis.
2) Semen culture and antibiotic sensitivity test.
3) Antisperm Antibody test for husband and wife.
4) Blood for VDRL, HBs Ag , HIV , HIV Antibodies
- What about success rates of IVF & ICSI?
Overall, success rates for IVF have steadily improved over the last ten years.
AARUSH IVF & ENDOSCOPY CENTRE has set itself apart as one of the leaders in IVF & ICSI success rates. The success at our centre is 45 to 50% which is comparable with other centres throughout the world because we have class 10000 air handling unit installed to provide cleanest air with Five embryo culture incubators , three laminar flow work stations to further purify the air and use of the latest technologies.
- What Other Factors Affect IVF & ICSI Success Rates?
In addition to the quality of the IVF program itself, other factors contribute to IVF success rates.
Age of the female partner
Cause of infertility
Past history of any previous IVF attempts
Quality and number of eggs
- What is the duration of one IVF or ICSI cycle?
One complete IVF or ICSI cycle takes approximately 15 to 16 days. From Day 1 or 2 of menses the stimulation of the ovaries start by muscular or subcutaneous injections of hormones. The mean stimulation period is 10 days, depending on the reaction of the ovaries. The ovum pick up takes place within two days after stopping the stimulation (usually on day 12). Now the real IVF or ICSI follows in the laboratory. When fertilization occurs, embryos are transferred into the uterus (usually on day 14) and drugs supporting the uterus are given. After approximately 14 days a pregnancy test will show whether the IVF treatment has been successful or not.
- How many minimum visits and stay of patient is required for IVF or ICSI treatment?
After registration for IVF& consent, patient can inform the date of menses on phone, she is advised to take GnRH agonist injection s.c.in long protocol method or GnRH antagonist injections (injection can be ice-packed and given to the patient before hand at the time of registration). In this way patient visits can be minimized to 4 to 5 times in an IVF cycle when she is on gonadotropin injections. This is specially beneficial for our outstation patients. This reduces their stay, stress and cost. Patients have to stay in hospital for 2 to 3 hours on the day of ovum pick up and embryo transfer.
- What is ICSI?
Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.
- What are the indications for ICSI?
Indications
- It is especially useful for patients where the male partner has a very low sperm count (oligozoospermia), poor sperm motility (asthenozoospermia) or too many abnormal sperms (teratozoospermia).
- Also, in men with obstructive or non-obstructive azoospermia (zero sperm counts), sperm can be directly retrieved from the testis or the epididymis (TESE, PESA and used for ICSI, thus helping him to have his own biological child.
- Also patients of retrograde ejaculation or anejaculation (where electroejaculation and IUI have failed to give a pregnancy
- Also be used where eggs cannot easily be penetrated by sperm
- Unexplained infertility
- Patients having Immunological factor
- Repeated failed IVF
- Severe endometriosis
- What about the health risks for children born following infertility treatment?
Regarding children born following treatment with ovulation promoting drugs, IVF and ICSI procedure the incidence of birth defects has never been found to be higher than that in the normal population.
- What are the common local side effects of hormone injections?
Common local side effects experienced by patients who receive gonadotropins by intramuscular injection include skin redness, swelling and bruising. Pain and discomfort sometimes reported after intramuscular injections are now likely to be lessened with the availability of gonadotropins produced by recombinant DNA - or genetic engineering-techniques, which are administered by subcutaneous injection. The effect of hormone injections on the body lasts only for that cycle.
- What is Ovarian Hyper Stimulation Syndrome (OHSS)?
Ovarian Hyper Stimulation Syndrome (OHSS) is a side-effect that can occur during infertility treatment with ovulation inducing drugs. Symptoms of this syndrome may include ovarian enlargement, accumulation of fluid in the abdomen and gastrointestinal disorders (nausea, vomiting, diarrhea). Severe cases of OHSS are however very rare (1-2% of cases) and may decrease urine output and may go into DIC and shock. Patients if treated early by high protein diet, amino acid injections, tapping of ascitic fluid and replenishing with adequate amount of IV fluids may be prevented from severe complications.
- How do multiple births occur?
Multiple births occur more frequently after infertility treatment than in the normal population. About 80% of pregnancies achieved following simple ovulation induction with gonadotropins result in single births, the remaining 20% being multiple pregnancies, mostly twin pregnancies. After IVF, one pregnancy out of four is multiple (20% twin pregnancies and 3-4% triplets). We transfer either a single blastocyst on day 5 or three good 4 celled embryos on day 2 after fertilization, to further reduce the chance of multiple births.
- What is Embryo Reduction?
Assisted Reproductive Therapy (ART) has caused an increase in multiple pregnancies. This situation is especially seen in ovulation induction and Intra Uterine Insemination. In order to prevent the risk of severe premature birth and handicaps as well as risks for the mother, embryo reduction is sometimes performed. The number of embryos in the uterus is reduced and the remaining pregnancy has a better chance of normal development and delivery. Of course this is not an easy decision for either the patients or the doctor. With careful guidance of the patient during treatment and good counseling when the patient is at risk for a large multiple pregnancy, many triplets or higher order pregnancies may be avoided.
- How is Embryo Reduction done?
The reduction procedure is generally carried out during the first trimester. The most common method is to inject a chemical solution or feticide into the fetus or fetuses selected for either genetic reasons or for ease of accessibility.At our clinic we inject potassium chloride into or in the vicinity of the foetal heart thereby causing it to stop functioning under general anaesthesia under sonography guidance by embryo reduction needle introduced transvaginally. Generally, the fetal material is reabsorbed into the woman's body. Patient is treated like a case of threatened abortion.
- What is blastocyst ?
A blastocyst is an embryo that has developed for five to six days after fertilisation.
- What are the pros and cons of blastocyst transfer?
Blastocyst transfer can be highly successful for some groups of women, but it isn’t right for everyone and does have some drawbacks:
- Blastocyst transfer can result in a higher likelihood of becoming pregnant when compared with 2–3 day embryo transfer in certain groups of women.
- However, if you opt for blastocyst transfer, you may not get any embryos that develop to the blastocyst stage.
- There may also be fewer embryos to freeze.
- If your embryos do develop to the blastocyst stage and multiple blastocyst transfer is used, you are at greater risk of producing twins.
- What is PCOD?
Patients suffering from polycystic ovarian disease ( PCOD ) have multiple small cysts in their ovaries. These cysts occur when the regular changes of a normal menstrual cycle are disrupted. The ovary is enlarged; and produces excessive amounts of androgen and estrogenic hormones. This excess, along with the absence of ovulation, may cause infertility.
- How is PCOD diagnosed
- The typical medical history is that of irregular menstrual cycles.
- Patients suffering from PCOD are often obese and may have hirsutism (excessive facial and body hair) as a result of the high androgen levels.
- This diagnosis can be confirmed by vaginal ultrasound, which shows that both the ovaries are enlarged; the bright central stroma is increased ; and there are multiple small cysts in the ovaries. These cysts are usually arranged in the form of a necklace along the periphery of the ovary.
- Blood tests are also very useful for making the diagnosis. Typically, blood levels of hormones reveal a high LH ( luteinising hormone) level; and a normal FSH level ( follicle stimulating hormone) ( this is called a reversal of the LH : FSH ratio, which is normally 1:1); and elevated levels of androgens ( a high dehydroepiandrosterone sulphate ( DHEA-S) level).
- What is the cause of PCOD ?
- We don't really understand what causes PCOD, though we do know that it has a significant hereditary component, and is often transmitted from mother to daughter.They usually have family history of diabities.
- We also know that the characteristic polycystic ovary emerges when a state of anovulation persists for a length of time.
- Patients with PCO have persistently elevated levels of androgens and estrogens, which set up a vicious cycle.
- Obesity can aggravate PCOD because fatty tissues are hormonally active and they produce estrogen which disrupts ovulation .
- Overactive adrenal glands can also produce excess androgens, and these may also contribute to PCOD.
- These women also have insulin resistance ( high levels of insulin in their blood, because their cells do not respond normally to insulin).
- How is PCOD treated?
In patients who are planning to conceive, PCOD can be treated by loosing weight and use of tab metformin to overcome insulin resistance. Ovulation induction drugs along with gonadotropin injections may be given to achieve ovulation. Patients with high LH may require down regulation with GnRH agoinst or antagonist injections.
In patients who are not planning to conceive drugs like oral contraceptive pills and cyproterone acetate may be given to regularize the cycles and reduce androgen levels along with weight loss metformin tablets and lifestyle modifications.
- What is the role of IVF in PCOD patients?
If 3 to 6 cycles of IUI have failed, then IVF is the best treatment option for patients with PCOD.
- What is endometriosis?
It is a gynecological condition in women , in which endometrial-like cells appear and flourish in areas outside the uterine cavity, most commonly on the ovaries and are influenced by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle.
- What are symptoms of endometriosis?
Patients may have dysmenorrhea , chronic pelvic pain, dyspareunia, dysuria, Infertility, Constipation, chronic fatigue, heavy or long uncontrollable menstrual periods with small or large blood clots, gastrointestinal problems including diarrhea, bloating and painful defecation, extreme pain in legs and thighs, premenstrual spotting, mild to severe fever, headaches, depression & anxiety.
- What is the treatment for endometriosis?
Drugs like danazol, progestogens, GnRH injections may be given but today laparoscopic surgery has become common place in the management of patients with endometriosis and infertility. The goal of conservative surgical procedures are to remove all implant, resect adhesions, relieve pain , reduce the risk of recurrence and adhesion formation and restore the normal anatomy and physiology.
- What is the need for IVF in endometriosis?
If IUI treatment or expectant treatment or surgery has failed in achieving pregnancy within two years of treatment or if endometriosis has affected fallopian tubes.
- What is egg donation?
In egg donation, eggs are borrowed from a young woman (less than 33 yrs of age) called the donor, with her consent. These eggs are then fertilized with the sperms of the husband of the recipient woman and the resultant embryo is inserted into the womb of the recipient.
- What are the indications of egg donation?
- Congenital absence of eggs(by birth)
- Turner syndrome
- Gonadal dysgenesis
- Acquired reduced egg quantity / quality
- Oophorectomy
- Premature menopause
- Chemotherapy
- Radiation therapy
- Autoimmunity
- Advanced maternal age
- Compromised ovarian reserve
- Resistant ovary syndrome
- Severe endometriosis
- Other
- Diseases of X-Sex linkage
- Repetitive fertilization or pregnancy failure
- Ovaries inaccessible for egg retrieval
What is embryo donation?
This procedure is similar to egg donation. However, instead of borrowing the egg and using the recipients husband's sperm for fertilization, both the egg and the sperms are derived from donors.
What is the treatment for azoospermia ?
Nowadays azoospermic men can have their own genetic baby by newer sperm retrieval techniques followed by ICSI.
Sperm Retrieval Techniques
PESA (Percutaneous Epididymal Sperm Aspiration)
In this method sperms are obtained by puncturing the epididymis with 26 no. needle attached to 1ml syringe and gentle suction is done. It is simple, convenient, inexpensive procedure which can be done under local anaesthesia.
MESA (Microsurgical Epididymal Sperm Aspiration)
In this method sperms are obtained by using operating microsope after exposing epididymis.
TESA (Testicular Sperm Aspiration)
In this method sperms are obtained by sucking out testicular tissue by inserting 18 no. scalpvein in the testis and suction is applied by 20ml syringe attached to it. The testicular tissue is teased under the microscope.
SSTA (Single Seminiferous Tubule Aspiration)
This method is useful for patients with focal spermatogenesis.Single seminiferous tubule is aspirated from various sites after opening skin but without opening tunica vaginalis.
TESE (Testicular Sperm Extraction)
This method is used in patients with non obstructive azoospermia. This is an open procedure just like conventional testicular biopsy. The tissue is placed in culture media and seminiferous
tubules are teased to obtain sperms.
Note : These sperms can be cryopreserved with almost same rate of fertilization and pregnancy as fresh sperms.
What is Cryopreservation?
Cryopreservation means preserving in a frozen condition in liquid nitrogen at minus 196 degrees in cryocans. The best known cryopreservation is of semen. This is mostly done in case of cancer of the testicles before treatment of the cancer. Furthermore cryopreserved semen is used in donor insemination. It is also possible to freeze fertilized eggs after IVF or ICSI. If more embryos are left after an IVF or ICSI procedure they can be frozen and transferred another time. In this way there is another chance of a pregnancy while only one IVF or ICSI cycle is performed.
Vitrification is the process of freezing embryos whereby the solution containing the embryos is cooled so quickly that the structure of the water molecules doesn’t have time to form ice crystals and instantaneously solidifies into a glass-like structure unlike previous slow freeze methods, which took up to two hours to lower the embryo to the correct temperature & the fluid inside the cells can form ice crystals that expand and damage the cell membranes.
What is Extra Uterine Pregnancy (EUP)?
When a pregnancy is not located in the uterus it is called an Extra Uterine Pregnancy (EUP) or ectopic pregnancy. The most common place for an EUP is the fallopian tube but sometimes the ectopic pregnancy is located elsewhere, such as in the cervix, the ovary or in the abdomen. EUP is a rare disease and occurs in 1% of all pregnancies. With IVF treatment the risk can increase. Risk factors for EUP are a history of infection of the tubes (salpingitis), chlamydia infection, Pelvic Inflammatory Disease (PID), former EUP, operation on the tubes or in the lower abdomen, endometriosis and appendicitis. The symptoms of ectopic pregnancy are often similar to those of a normal miscarriage and may include a positive pregnancy test together with or without vaginal bleeding and abdominal pain .Mostly the ectopic pregnancy will be removed surgically usually laparoscopically but occasionally medical treatment or expectant treatment is offered when the pregnancy is very small and thorough control of the patient is possible.
What is hysteroscopy?
Hysteroscopy is a procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.
What is hysteroscopy used for?
This procedure allows us to see if there are any uterine cavity defects such as:
- Fibroid tumors
- Endometrial polyps
- Intrauterine scar tissue
- A bicornuate uterus or septate uterine malformation
- Other uterine problems
- In failed IVF cycle for any uterine pathology
What is operative hysteroscopy ?
The technique of hysteroscopy has also been expanded to include operative hysteroscopy. Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy at the time of diagnosis.
The procedure is very similar to diagnostic hysteroscopy except that operating instruments such as scissors, biopsy forceps, electocautery instruments, and graspers can be placed into the uterine cavity through a channel in the operative hysteroscope. Fibroid tumors, scar tissue (synechiae or adhesions), and polyps can be removed from inside the uterus. Congenital abnormalities, such as a uterine septum, may also be corrected through the hysteroscope.
What is hysteroscopic tubal cannulation?
A relatively new method for treating proximal tubal obstruction (cornual blocks, where the tubes are blocked at the utero-tubal junction) is that of hysteroscopic tubal cannulation. Many studies have shown that this kind of block is often because of mucus plugs or debris which plug the tubal lining at the uterotubal junction which is as thin as a hair. It is now possible to pass a fine guidewire through the hysteroscope into the tubes, and thus remove the plug or debris and open the tubes - thus restoring normal tubal patency with minimally invasive surgery.
How do fibroids (myomas) affect fertility?
Most fibroids develop in the wall of the uterus (intramural) or protrude outside of the uterine wall (subserous fibroids), and these can usually be left alone, since they do not hinder fertility, and neither do they cause problems during the pregnancy.
Submucous fibroids are an important cause of infertility, because they interfere with implantation of the embryo, by acting as a foreign body. These are best removed by an operative hysteroscopy. While surgery can remove the fibroid, it can recur again, and most doctors advise the patient to try to conceive as soon as possible after surgery.
What Is Laparoscopy?
Laparoscopy is a surgical procedure that involves making two to 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 to see the abdominal organs and sometimes make repairs, without making a larger incision that can require a longer recovery time and hospital stay.
When Is Laparoscopy Done?
Laparoscopy is done for diagnosing a cause for infertility. Usually, it is performed only after other infertility testing has been completed.
If you’re experiencing pelvic pain, a potential symptom of endometriosis or PID, laparoscopic surgery may determine the source of pain and possibly treat it.
Laparoscopy also allows biopsy of suspicious growths or cysts.
Laparoscopic surgery can treat some causes of infertility, for better chance at getting pregnant either naturally or with fertility treatments like ovarian drilling in PCOD patients , adhesiolysis , fulguration of endometriosis etc.
Laparoscopy is also done for ectopic pregnancy.
Which infertile patients should have laparoscopy?
Generally, laparoscopy should be reserved for couples who have already completed a more basic infertility evaluation including hormone investigations , assessing for ovulation, ovarian reserve , ultrasound for the female and semen analysis for the male. Some couples may elect to skip laparoscopy in favor of proceeding to other fertility treatments such as superovulation with fertility medications combined with intrauterine insemination or in vitro fertilization . There may be instances where there is high suspicion for finding problems with laparoscopy for instance, if a woman had a history of a severe pelvic infection or a ruptured appendix, this would increase the likelihood that she may have pelvic adhesions and therefore more likely to benefit from early laparoscopy.
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