Surgical Options for Infertility

Microsurgery has led to dramatic advances in infertility treatment. Gynecologic surgeons can correct fertility problems previously considered incurable.

Microsurgery is different from conventional open surgery. With magnification from two to 30-fold by an operating microscope, surgeons have excellent visualization. They can then use delicate tissue handling techniques and very fine suture materials to minimize skin irritation. The laparoscope is similar in theory to a telescope. It is inserted into the pelvic cavity through a small incision in the navel. Lighting and visualization are greatly enhanced.

Pelviscopy refers to a special type of operative laparoscopy, in which more extensive surgical procedures are performed. Magnification is provided by laparoscope lenses, and video monitoring may allow the surgical assistant to work as one with the surgeon. Pelviscopy is used in the treatment of ectopic pregnancy, uterine fibroids, ovarian cysts and tumors, endometriosis, and pelvic adhesions.

Pelviscopy, when used properly, offers numerous advantages. The surgeon can avoid an open abdominal incision, so procedures can be performed on an outpatient basis. It minimizes discomfort, and there is no visible surgical scar. Most importantly, in many cases the laparoscopic approach produces better results than other types of surgery, probably as a result of decreased tissue trauma and less adhesion formation.

Some of the commonly performed reproductive surgeries are:

Tubal Ligation Surgery Reversal

Many women who undergo tubal ligation surgery later choose to have a baby. These women have two options available to them, IVF or tubal reanastomosis (reversal surgery). Factors that influence the success rate of tubal reversal surgery include age, prior sterilization technique, other prior surgeries, and the presence of pelvic disease such as fibroids or endometriosis.

At the Reproductive Science Center (RSC), tubal reanastomosis surgery is performed by two physicians: Dr. Carol Anania and Dr. Ania Kowalik. Tubal reversal is a highly successful procedure when preformed by an experienced surgeon.  Dr. Anania and Dr. Kowalik have extensive laparoscopic experience and prior training. 

To explore your reproductive options  schedule a consultation with one of the physicians.  You will be asked to bring a copy of the medical record/surgical report of your tubal ligation procedure for your RSC doctor to review. This information impacts the odds for successful pregnancy after tubal reversal surgery. During an initial consultation, the doctor can review your medical history, discuss with you the pros and cons of tubal reversal surgery and IVF, and help you choose the procedure that is right for you.

In most cases tubal reversal surgery is a successful and effective option for pregnancy after sterilization. With pregnancy rates averaging 75%, tubal reversal is a treatment option worth considering. It particularly deserves consideration if more than one pregnancy is planned.

 Historically, microsurgical tubal reanastomosis was only performed as an open surgery through a 3 inch “bikini” incision made just below the pubic hairline. This form of the procedure is still available. Using magnification to enlarge the image of the fallopian tubes, the blocked ends of the tubes are opened and reconnected.  This technique often requires an overnight hospital stay and 3 to 4 weeks of post-operative recovery.

Minimally invasive laparoscopic techniques were developed to minimize the size of incisions and to decrease the duration of post-operative recovery.  Reproductive Science Center physicians, Dr. Anania and Dr. Kowalik, have been able to offer their patients a laparoscopic method of precise tubal reanastomosis involving incisions that are as small as 3 mm. Utilizing much finer and more delicate instruments and fine suture, laparoscopic surgery can be performed with the accuracy of a microscopic open procedure, while the recovery time is shortened to less than 1 week.

Tubal reversal is an outpatient surgery, performed by Dr. Anania and Dr. Kowalik at the Lahey Clinic in Burlington, Massachusetts. Surgical options available to RSC patients include both:
          - microsurgical tubal reanastomosis via laparotomy
          - minimally invasive laparoscopic reanastomosis

If after your initial consultation, you decide to proceed with IVF rather than tubal reversal surgery, the Reproductive Science Center can offer high chances for success and financing options.

This information is provided for general education purposes and is not intended to take the place of a discussion with your physician. If you have questions about any aspect of your health, you are advised to speak with your physician.