Fertility treatments - Fertility surgery
Fertility surgery means operations to investigate or improve a woman's fertility.
First of all, we need to distinguish between diagnostic or exploratory surgery on the one hand and operative or corrective surgery on the other.
Diagnostic ('exploratory') surgery mainly consists of a hysteroscopy, laparoscopy and chromopertubation. This surgery is done close to the beginning of the fertility treatment, as part of the evaluation of the pelvic anatomy.
During the hysteroscopy, the uterus is examined with a small endoscopic device (camera) inserted through the cervix. Therefore it does not require any cuts or incisions. The cervix is merely medically dilated a little because of the gas pressure of the hysteroscope. This allows us to diagnose polyps and/or fibroids and/or intrauterine growths that affect the uterine cavity. In many cases, these abnormalities can also be corrected during the same operation, using very fine instruments (transition to operative hysteroscopy).
Then we do the laparoscopy, which does involve a small incision under the navel. First air is blown into the abdominal cavity through this incision to create space. Then an endoscope is inserted again using a small tube (trocar) through the navel. From this access point, we can check the womb, fallopian tubes and ovaries. This allows us to diagnose certain conditions that may lead to fertility problems. Examples of such conditions are endometriosis or changes to the fallopian tubes resulting from infections, with fibrosis or adhesions. If such conditions are diagnosed, it is possible in certain cases to switch immediately to an operative laparoscopy operation, detaching the growths found or vaporising any endometriosis. Blockages of the fallopian tubes can sometimes also be dealt with in this way.
Finally, a chromopertubation is administered. This is actually a test of whether the fallopian tubes are working properly. A coloured dye, methylene blue solution, is injected into the womb. If the fallopian tubes are unblocked, we can see the dye passing through. Sometimes, however, the intrauterine pressure needs to be increased for the dye to pass through. This indicates that there is a blockage in the fallopian tubes.
As you will realise from the above, the borderline between diagnostic and operative fertility surgery is sometimes extremely unclear. Diagnostic operations can easily turn into (limited) operative surgery during the same session. In more difficult situations, however, more specialised surgery is required, for example an extensive laparoscopy following thorough cleaning of the intestines, if there is a risk of intestinal injury.
Sometimes it is not possible to correct existing conditions endoscopically either, and a microsurgical laparotomy, surgery involving an abdominal incision, is required. Then it is possible, for example, to repair the fallopian tubes under the microscope. A laparotomy is still the standard treatment, for example, for sterilisation reversal treatments.
In recent years, however, robotic surgery is used increasingly often. This means that very complex operations can be carried out endoscopically, which is much easier for the patient and allows more rapid recovery. We are also making increasing use of robots such as the Da Vinci® robot at Jan Palfijn General Hospital for fertility surgery.