A certain number of innate (congenital) or acquired disorders can reduce fertility or prevent pregnancy altogether. These disorders can affect the uterus, fallopian tubes or ovaries.
These « mechanical » alterations can often be repaired either partly or in full by
hysteroscopy or
laparoscopy.
Surgical hysteroscopy
This comprises the various surgical procedures aimed at restoring a normal uterine cavity if the latter is deformed. It concerns (endometrial) polyps, intracavity fibromas and synechiae.
In principle, surgical hysteroscopy is performed in an operating theatre under partial or general anaesthesia. It involves dilatation of the Cervix uteri but no incision.
Surgical laparoscopy
This is carried out in the same way as a diagnostic laparoscopy but may sometimes require a 3rd sub-public incision. As regards infertility, this procedure can be carried out on the :
Fallopian tubes :
- Repair of a narrowing or occluded fallopian tube at its tip ;
- Anastomosis (microsurgical vasectomy reversal) in the case of a proximal obstacle following inflammation of ligature of the fallopian tube. A “robot” is often used in such cases in order to ensure a high level of accuracy when stitching back the two segments of the fallopian tube, which are less than 1 mm in diameter in this region. A microsurgical procedure is carried out by laparoscopy. The Clinique Générale-Beaulieu houses the Swiss multidisciplinary centre for robot-assisted surgical laparoscopy ;
- Release of adherences ;
- Removal (rather rare) of an extremely damaged fallopian tube prior to IVF, in order to increase the chances of successful therapy ;
Ovaries :
- Cyst resection ;
- Ovarian drilling. This procedure is intended to facilitate ovulation in women presenting with an ovulation disorder known as polycystic ovaries and responding poorly, if at all, to conventional medicinal therapy.
Uterus :
- Myomectomy (ablation of one or more fibromas whilst preserving the uterus) is the most common procedure ;
On a more general note, laparoscopy can be carried out to treat endometriosis, which is often associated with infertility.
