Fertility surgery

What is fertility surgery?

Fertility surgery aims to improve fertility, particularly in women. Certain conditions, such as endometriosis and uterine fibroids can impair fertility.

In selected cases, surgery can help alleviate these problems. Moreover, the internal organs can be examined more closely during these procedures to determine the cause of infertility. 

How can fertility be improved surgically?

In general, the required surgical procedure depends on the underlying condition of the patient. The primary goal of fertility surgery is to identify the possible causes for the infertility experienced by the patient as well as to treat them, where possible.

In most cases, these procedures involve removing any tissues that mechanically obstruct the transport or implantation of a fertilized egg and thus, prevent pregnancy. For example, these tissues can reduce the space in the uterus or displace important organ structures.

Such mechanical obstructions include occlusions of the fallopian tube, abdominal or pelvic adhesions, tumors, endometriosis lesions, or ovarian cysts.

Fertility surgery may help improve fertility by surgically removing an anatomic obstruction that hinders conception or early pregnancy. 

What surgical procedures for infertility are there? 

In many cases, a hysteroscopy is performed. This involves inserting a small endoscopic camera transvaginally into the uterus to assess the organ, identify and/or remove pathological findings. 

This requires the insertion of additional instruments through the vagina, for example, to release adhesions or remove uterine fibroids. 

Furthermore, a laparoscopy may be performed, where a small camera and additional instruments are inserted through small incisions in the abdominal wall. This allows for examination of the uterus, ovaries, and fallopian tubes, as well as presents an opportunity to remove any abnormalities minimally invasively.

This procedure is indicated when the cause of infertility is located outside of the uterus. Examples of such conditions are diseases affecting the ovaries (e.g. polycystic ovary syndrome) and fallopian tubes (e.g. adhesions or occlusions). Similarly, uterine fibroids may be located externally and cannot be accessed during hysteroscopy. Laparoscopy and hysteroscopy can also be performed during the same session. 

Some of the most relevant fertility surgeries include the removal of uterine fibroids and endometriosis lesions, surgical correction of congenital uterine anomalies (e.g. uterine septum), and lysis of intrauterine adhesions (adhesiolysis). In addition, cysts (fluid-filled sacs) or benign tumors (e.g. dermoid cysts) can also be removed if they impair fertility.

Another important aspect is surgical reconstruction of the fallopian tubes when they are occluded or otherwise damaged. This also involves a procedure called chromopertubation. Dye is injected into the uterus and laparoscopically assessed for any leakage from the fallopian tubes into the abdominal cavity.

Tube patency is indicated by passage of the dye, which is a requirement for natural conception. Potential adhesions or obstructions can be treated surgically.

Similarly, polycystic ovary syndrome (PCOS) can be surgically treated with ovarian drilling to improve fertility.

Most fertility surgeries can be performed using minimally invasive approaches.

The role of fertility surgery for infertility

Fertility surgery remains an important aspect of infertility management. This is particularly true for conditions that may cause infertility but are easily treatable with surgery. 

For example, removing uterine fibroids or malformations, or reconstructing occluded fallopian tubes may enable natural conception without necessitating medications or assisted reproductive techniques (in vitro fertilization).

It is always necessary to determine the underlying cause. For instance, infertility due to hormonal imbalances cannot be treated surgically. Whereas anatomical abnormalities respond well to surgical treatment. Today, fertility surgery represents an additional measure alongside the constantly evolving assisted reproductive technologies. 

In certain cases, fertility surgery can improve the chances of success of assisted reproduction.

What physicians and clinics specialize in fertility surgery?

Fertility surgeries are generally performed by gynecologists, who are often specialized in reproductive medicine, including infertility management. These procedures often take place in fertility centers where gynecologists work closely with endocrinologists and surgeons.

Patients seeking medical care naturally wish to receive the best medical care. Patients often ask themselves: Where can I find the best clinic? This question cannot be objectively answered as no reputable physician would claim to be the best. Therefore, clinical experience is one of the most reliable indicators.

We want to help you find an expert for your condition. All listed physicians and clinics have been carefully reviewed and selected based on their high level of specialization in fertility surgery and are available to receive inquiries or treatment requests.