Reproductive Surgery
Surgery can play an important role in correcting, restoring or preserving the anatomy and function of a woman’s reproductive system. In some cases, surgery will increase the possibility of spontaneous pregnancy, improve the results of medically assisted reproduction techniques or preserve the fertility of women at risk of premature ovarian function loss, particularly those undergoing chemotherapy or radiotherapy for the treatment of an oncological disease.
On the other hand, surgical procedures also present a risk of complications and failure, so their indication and technique must be assessed on a case-by-case basis by experienced teams, and their benefits and risks must be weighed against the woman’s wishes and expectations. .
Assessment of the infertile couple is essential to identify the possible causes of infertility and to establish a correct treatment plan, which may include medication, assisted reproduction techniques and/or surgery.
Possible surgical approaches
A minimally invasive technique in which a fine instrument is inserted into the vagina and cervix to visualise the inside of the uterus and correct any changes that are found. Depending on the context, it can be performed in the surgery without anaesthetic or under local anaesthetic only, or in the operating theatre under general anaesthetic.
Laparoscopy is another type of minimally invasive surgery that allows surgery to be performed in the abdominal and pelvic cavity through small incisions in the abdominal wall, through which a camera and surgical instruments are inserted. Compared with open surgery, laparoscopy is associated with a lower risk of surgical complications, less pain and faster post-operative recovery. It also offers a better aesthetic result, given the small size of the scars (5-10 mm).
In some cases, it may be necessary to perform surgery through a conventional incision in the abdomen.
Causes of infertility for which surgery may be indicated
Uterine fibroids are benign tumours of the muscular wall of the uterus and are very common in women of childbearing age. Many women with fibroids have no symptoms at all, or they may take several years to develop. In women with symptoms, the most common complaints are heavy, prolonged periods (which can lead to anaemia) and pelvic pain or pressure.
The presence of fibroids in the uterus can impair a woman’s reproductive capacity and be a cause of infertility and miscarriage. Fibroids that deform the inside of the uterus appear to have the greatest impact on fertility and surgery to remove these fibroids can be effective in reversing this impairment. Depending on the size and location of the fibroids, surgery to remove them (myomectomy) may be performed by hysteroscopy, laparoscopy or open surgery.
Endometriosis appears to cause infertility by a number of different mechanisms, which may vary depending on the location and stage of the disease in each woman. It is thought that the inflammatory environment caused by the disease in the reproductive organs can interfere with the normal development of the follicles, fertilisation of the oocyte and implantation of the embryo.
In more advanced stages, however, endometriosis causes a distortion of the normal anatomy of the affected organs, which may become deformed and adhere to each other, thus compromising the ovulation process and the capture of the eggs by the fallopian tube, preventing progress. of spermatozoa, cause dysfunctional uterine contractions and prevent fertilisation and embryo transport.
In women with symptoms of endometriosis, laparoscopic surgical treatment may be the solution to improving symptoms, restoring anatomy and improving fertility. Studies show that fertility rates in these patients can double after surgery. Furthermore, when endometriosis develops in the ovaries in the form of cysts (endometriomas), it may be necessary to treat them surgically before proceeding with medically assisted reproduction techniques.
Certain changes in the endometrium (the tissue that lines the inside of the uterus) can interfere with fertility, such as inflammatory conditions, scarring or polyps. Hysteroscopy is used to diagnose and treat these changes.
Malformations of the uterus can cause infertility or miscarriage. Certain malformations, such as uterine septal defects, may require surgical correction by hysteroscopy.
Dilated or blocked fallopian tubes can be a cause of infertility. Depending on the type of change in the tubes, laparoscopy may be necessary to correct tube deformities and obstructions or, on the contrary, to remove distended tubes (hydrosalpinx), as their presence compromises the success of in vitro fertilisation.
Polycystic ovary syndrome (PCOS) is a condition that affects around 10% of women of childbearing age and can lead to menstrual irregularities, excess male hormones and infertility. In certain cases of infertility where drug treatment is not effective, laparoscopic ovarian drilling may be an alternative. During this surgery, several holes are drilled into the surface of the ovaries, resulting in a reduction in male hormone levels and the resumption of cyclical ovulation. It should be noted that ovarian drilling is not a technique recommended for all women with PCOS and should be considered on a case-by-case basis.