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Evaluation of the Uterus and Fallopian Tubes
Laparoscopy
Laparoscopy is commonly used to diagnose and treat many conditions causing infertility. Drs. Davies and
Borkowski have extensive
advanced training in laparoscopy and the delicate microsurgical
techniques required to perform procedures such as tubal
reanastamosis. A reanastamosis is "reconnecting" the fallopian tubes that were previously severed for birth control. They also use the laparoscope to treat conditions such as endometriosis, where endometrial tissue must be carefully removed without harming the delicate reproductive tissues.
In some practices,
laparoscopy is recommended as a part of the fertility workup for most patients;
however, we prefer a more conservative approach. This
is especially true if the patient has had a previous
laparoscope. We decide whether or not to perform the
procedure based upon
each patient's history and diagnosis.
The diagnostic laparoscopy for infertility should be performed by a reproductive surgeon, fertility specialist. This is because many times conditions, such as severe endometriosis, noted in the diagnostic laparoscopy, can be treated during the procedure. The surgeon must have the necessary advanced training to correct these conditions. This avoids a second "treatment laparoscopy".
Many patients
have had previous unsuccessful treatments by the time
they see us and are immediately candidates for IVF.
These patients often include those with blocked tubes,
severe male factor, infertility from unidentified
causes, and those who have failed multiple attempts
of stimulated IUI cycles. There is little value in performing a laparoscopy
for these patients.
The laparoscopy
is performed as an outpatient procedure under general
anesthesia. Two small incisions
are made in the abdomen; one at the belly button and
one above the pubic bone. Scars are usually not noticeable
after a laparoscopy. The abdomen is "inflated"
with gas that enables the physician to clearly view the internal organs. A small "telescope"
is inserted through one of the incisions and the operative
tools are manipulated through the other.
Laparoscopic surgery is also used to treat other diseases
such as fibroids, tubal disease, perform hysterectomies,
treat the lining of the uterus, and many other conditions.
Compared to "open surgery", laparoscopy results in a much shorter recovery time,
reduced pain, lack of scarring, less adhesion formation,
and reduced chance of infection.
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