Surgery may be an option for some with infertility. It can help by:
- Repairing structures that are not working as they should
- Starting a pregnancy
Procedures to Correct Anatomic Abnormalities
Certain problems can make pregnancy hard or impossible. Surgery may fix these issues. It may be an option for:
- Fallopian tube obstructions
- Uterine fibroids
- Scarring of the ovaries or other pelvic tissues due to pelvic inflammatory disease (PID)
Laparoscopyis done through small cuts in the belly. The cuts may be around the belly button or lower. Recovery time is often shorter with this type of procedure compared to open surgery with large incision.
A scope is passed through the cuts. It has a light and a camera that will send images to a screen in the room. The images will be used to guide the doctor. Other tools will be passed through the cuts. They can be used to take removal of scar tissue, place implants, or repair blocked tubes. It may also be used to find what may be causing problems. Once the surgery is done the cuts will be closed with stitches or clips. A dressing will be placed over the area.
Laparotomy microsurgery is like the laparoscopy. This option uses a larger cut in the belly. The surgeon will also use a special microscope to see the organs.
A hysteroscopy does not need cuts in the belly. Instead the scope is passed through the vagina and into the uterus. The scope sends images to a screen in the room. The doctor will use it to check out the organs. Tools can also be passed with the scope to do some work. A hysteroscopy may be used to treat abnormal bleeding, fibroids, and uterine polyps or more.
The scope and tools will be passed from the vagina through the cervix and into the uterus. The doctor will be able to remove scar tissue, adhesions, small fibroids and polyps. Devices can also be placed in the uterus. A hysteroscopy may also be used to diagnose problems.
Assisted Reproductive Technologies (ART)
ART is a procedure to start a pregnancy without sex. The egg and sperm can be from you and your partner or can be from a donor. They will be combined to form an embryo. The embryo will be placed in you or your partner’s uterus or in the uterus of a surrogate.
ART methods include:
Semen is collected. The sample is treated in a lab and then placed into the cervix or uterus. The egg is fertilized in the body. It may be more successful if it is done twice during a menstrual cycle instead of once. Artificial insemination is an option for couples who have:
- A low sperm count or problems with sperm mobility
- Problems with cervical mucus
- Sexual dysfunction
Sperm may be placed inside the mother. The baby will have genetics of mother and sperm donor. If the sperm is used in a surrogate mother the baby with have genetic material from sperm donor and surrogate.
IVF is done over several stages. First, hormone treatments will be used to mature eggs in the ovaries. When the eggs are ready they will be removed. The doctor will use a long thin needle. It will be passed through the vagina. An ultrasound will help to guide the needle to the right spot. The mature eggs will be pulled through the needle. The entire procedure usually takes 10-20 minutes. Anesthesia may be used to numb the area.
The eggs will be prepared in a lab. They will then be placed in an incubator. The temperature and humidity can be controlled there. Next, sperm is placed in the same dish. The eggs are checked after 24 hours. If they were fertilized certain changes will have occurred. In 2-5 days, fertilized eggs will grow into multiple-cell embryos. The embryos are drawn up into a plastic tube. The tube will be used to release the embryo in the uterus. Hormone therapy may continue for several days. Blood hormone levels will be watched. A pregnancy test is usually done within 12-14 days. This will show if an embryo has implanted and a pregnancy has begun.
In some cases, more embryos develop in the lab than should be placed into the uterus. These embryos can be frozen and kept. The process is called cryopreservation. The frozen embryos can be thawed and used for later rounds of IVF. The eggs and/or sperm may be donated or they may come from the intended parents.
There are several types of the IVF procedure:
An egg is removed from the body. It is mixed with sperm in a lab. The egg and sperm mix is then placed right into the fallopian tubes. The egg not yet fertilized.
An egg is removed from the body. It is mixed with sperm in a lab. The egg will be watched until it is fertilized and an embryo forms. The embryo is then placed in your fallopian tube instead of the uterus.
A pregnancy may not be possible if the uterus does not work well. In this case, eggs may be removed from the mother. They will be mixed with sperm and placed into a surrogate.
Sometimes the egg will need to come from a donor. The implant will follow the same steps with donated egg and sperm. In either option, sperm may come from partner or be donated.
- Reviewer: Monica Zangwill, MD, MPH
- Review Date: 09/2018 -
- Update Date: 09/25/2018 -