FERTILITY ENHANCING LAPAROSCOPY & HYSTEROSCOPY
Laparoscopy is an important procedure in the evaluation and treatment of an infertile patient. Inspection of the abdomen and pelvis through the laparoscope gives us a direct visual of the pelvic organs involved in a woman’s fertility and enables us to carry out corrective procedures to enhance fertility.
- Direct visualization and assessment of patency of fallopian tubes ( the most important organ for fertility to transmit the embryo to the ute
- Clearance of pelvic endometriosis including removal of cyst
- Drilling of ovaries in severe cases of poly cystic ovarian disease (PCOS) where medicines are not able to induce ovulation
- Opening of fallopian tubes
- Removal of tubal ectopic pregnancy
- Clipping of tubes before IVF if needed, to improve implantationrus).
- Removal of adhesions between tubes, ovaries, and uterus to restore fertility
- Removal of cyst and tumours from ovary or fibroids and adenomyoma from the uterus, which may interfere with a woman’s fertility.
Laparoscopic surgeries require shorter hospitalization. The women have smaller and cosmetically better scars with minimal pain and wound infection post-surgery with lower chances of adhesions inside the abdomen. There is faster recovery and resumption of normal activity with laparoscopy as compared to open surgery.
Expertise of the operating surgeon during laparoscopic surgery is very important as this procedure has developed in the last quarter century only and all gynaecologists may not have the expertise required for successful laparoscopic surgery. The complications are similar to that of an open surgery. However, inability to perform the procedure due to technical shortcomings or extreme obesity or poor visibility due to prior surgery could be there. Open surgery should be undertaken in the best interest of the patient whenever required.
Usually it takes between 30 – 60 minutes, but may extend to 3 hours depending upon the nature of the surgery.
Very little bed rest is required, as one can get out of bed within 2 hours of surgery unless advised otherwise. Walking, climbing stairs and resumption of basic activities can be done 4-6 hours post-surgery.
Slight pain and distension of the abdomen along with shoulder pain are common after surgery. However, this settles within 24 hours. Pain killers help whenever required. A slight pain at the stitch line may continue even up to 7 days, which is normal.
There may be some bleeding for a few days if the uterus or its cavity has been handled during a hysteroscopy, but this tends to subside on its own.
Laparoscopy procedures are routinely performed under general anaesthesia as day care cases, without the need for an overnight stay in hospital. However, a long procedure may require one or more days of admission depending on the exact nature of the procedure.
Usually, one to two days of low activity after surgery is sufficient for full recovery. However, one needs to follow the doctor’s advice.
Hysteroscopy is an operative procedure performed under general anaesthesia where a telescope called a Hysteroscope is introduced into the uterus through the vagina and cervix to visualize the insides of the uterus. This procedure can be combined with laparoscopy to have a complete assessment of reproductive organs inside the abdomen as well as the uterus.
Hysteroscopy visualizes the insides of the uterus to make sure that there are no pathologies like polyps, fibroids or adhesions between the walls of the uterus etc. which could prevent the woman from getting pregnant. Most problems can be corrected simultaneously by the operative hysteroscope.
It usually takes 4 – 6 hours after a regular hysteroscopy, to get discharged from the hospital. However, removal of large myomas might require overnight hospital stay.
Sometimes it may be difficult to introduce the hysteroscope into the uterus due to fibrosis or a cervical ridge. Also, on rare occasions, there could be bleeding, or perforation of the uterus. In some patients, difficulties may be experienced due to poor visualization of the uterine cavity due to a thick endometrium or poor distension of the cavity or technical limitations.