Reproductive Surgery

When couples seek help for infertility, they are introduced to the wide array of tests and treatments that are now available. Many of the terms involved can be bewildering, even worrisome - especially if the idea of surgery is mentioned. While the thought of surgery can be frightening, reproductive surgery is one of the many options that we now have to help attain pregnancy.

How Can Surgery Help?

Some of the obstacles to pregnancy include physical barriers such as endometriosis (fig. 1), the scarring of fallopian tubes or the presence of fibroids (fig. 2); in men, varicoceles (varicose veins in the scrotum) can often be the problem. Surgery is frequently indicated in these cases in order to remove the barrier to pregnancy. Also, men and women who have undergone sterilization (vasectomy or tubal ligation) must have surgery if they wish to regain fertility.

figure 1	figure 2

Which Surgery Is Done For Which Problem?

Doctors have several methods of surgery at their disposal. The procedure chosen depends on the patient herself, the presenting problem and the methods with which the surgeon is most comfortable. Most of these surgeries are available on an outpatient basis, barring any complications.

• Endometriosis: For women who are suffering from endometriosis, surgery can be done to remove, or lessen, the amount of tissue build-up along the lining of the uterus. This can be done through a mini-laparotomy in which the surgeon makes an incision in the abdominal wall to be able to reach the affected areas;
• Mini-laparotomy is performed through a small incision located just above the pubic area. The surgeon explores the pelvis and corrects the problem;
• Laparoscopy which involves a tiny incision that allows the surgeon to insert a fiber optic scope to visualize the problem. Additional small incisions are made to allow the doctor to introduce the instruments needed to perform the surgery;
• Hysteroscopy by which a tiny fiber optic scope is passed through the cervix and into the uterus. This scope allows the surgeon to see what is going on along the uterine walls and to correct certain abnormalities.
• Scarring, obstruction or damage from infection or other reasons: If there is scarring in the uterus, any of the above mentioned surgeries may be considered. If scarring is present in the fallopian tubes, the surgeon may opt for a falloposcopy which, like the hysteroscopy, involves the insertion of a small scope through the cervix. In this case the scope goes through to the fallopian tubes.
• Fibroids (benign tumors of the uterine muscle):
  
  Fibroids can be removed by:
• Laparotomy
• Colpotomy which involves an incision through the vagina or
• Laparoscopy, which allows the surgeon to use a tiny incision to see and remove fibroids through a scope.
• Reversal of tubal ligation: For women who wish to reverse a previous sterilization, the surgeon will most often choose a laparotomy microsurgery.

For men who are infertile, the conditions that require surgery are more limited:

• Varicocele (also referred to as varicose veins in the scrotum): Surgery to correct a varicocele involves a small incision, which allows the surgeon to tie off the varicose vein and restore fertility. A new treatment is being studied which involves blocking off the affected veins with pellets. A tiny incision is made in the leg or neck of the patient where a catheter is inserted and the doctor then releases the pellets through this catheter.
• Reversal of vasectomy: This surgery needs to be performed by a surgeon experienced in microsurgery.

What Are The Risks Involved?

As with all surgeries, a small risk is always present. These risks can involve reactions to anesthesia (general or local), infection and bleeding. Also, there is a slight chance that the individual surgeries can result in damage to the neighboring organs should a perforation occur.

Will My Insurance Cover These Surgeries?

While some insurance companies do not specify if they will include reproductive surgeries, some states mandate that certain procedures should be offered. However, these states often do not require that the procedures actually be covered.

In countries with socialized medicine such as Canada, Australia and England, national health care programs usually cover surgery for medical problems such as endometriosis and scarring. The surgery for sterilization reversal is frequently not covered nor are actual infertility treatments such as IVF (in vitro fertilization). Procedures not covered by the national health plans may be covered by some private insurances.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.


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