Reproductive Surgery

Reproductive surgery for female infertility aims to restore or enhance reproductive function by addressing structural issues like blocked tubes, scar tissue, or fibroids, often using minimally invasive techniques like laparoscopy and hysteroscopy. 

Laparoscopy is usually performed in an operating room on an outpatient basis, under general anesthesia. The instrument used is called a laparoscope - a small telescope that is inserted through a small incision in the abdominal wall.  It brings light into the abdomen, allowing the surgeon to see inside and repair any problems that are discovered.  

Hysteroscopy is a surgical procedure which allows the physician to inspect the inside of the uterus by inserting a hysteroscope (a small telescope about the size of a pen) through the vagina and cervix and into the uterus.  This procedure takes place in an operating room or a doctor’s office.  Liquid is placed into the uterus through the hysteroscope to separate the walls and allow inspection.  Fibroids, polyps, scarring, abnormal contour, and malignancies may be seen and corrected.

Common conditions that may require further investigation and/or repair with surgery include:

• Blocked fallopian tubes - surgery can be used to repair or unblock the tubes, allowing eggs to travel to the uterus. 
• Endometriosis - minimally invasive surgery can remove endometriosis tissue, which can be a cause of infertility and pain. 
• Uterine fibroids - myomectomy, the surgical removal of fibroids, can improve fertility if they are distorting the uterine cavity or causing other problems. 
• Ovarian cysts - cysts can sometimes interfere with ovulation or egg retrieval, and surgery may be necessary to remove them. 
• Scar tissue - scar tissue in the uterus or fallopian tubes can be removed to improve fertility. 
• Cervical stenosis - occlusion, partial or complete, can cause pelvic pain and difficulty in conceiving.  Cervical correction can be performed hysteroscopically to improve severe menstrual pain and allow easier access to the uterus to enhance pregnancy outcomes.

Most infertility cases do not require surgery. Other treatments, such as ovulation induction and intrauterine insemination (IUI) or in vitro fertilization (IVF), are often more appropriate. It's important to discuss all treatment options with your care team to determine the best course of action. 

Reproductive surgery for male infertility can be an effective treatment option depending on the cause of infertility. It is typically considered when there are identifiable anatomical or structural issues contributing to the infertility, such as blockages or varicoceles. Common surgical procedures include:

• Varicocelectomy - treatment of a varicocele (enlarged veins in the scrotum), which can impair sperm production. The dilated veins are tied off or removed to improve blood flow and sperm quality. Varicocelectomy can significantly improve sperm count and motility in some men.
• Vasovasostomy / Vasoepididymostomy - reversal of a vasectomy or treatment of a blockage in the vas deferens/epididymis. Pregnancy rates vary but can be quite high with a skilled surgeon.
• Testicular sperm extraction (TESE) - retrieval of sperm directly from th testicle when no sperm is present in the ejaculate (azoospermia). Small tissue samples are taken from the testes, sometimes with the use of an operating microscope. TESE is usually combined with IVF/ICSI (intracytoplasmic sperm injection).
• Epididymal sperm aspiration (PESA) - retrieval of sperm from the epididymis in cases of obstructive azoospermia. PESA is usually combined with IVF/ICSI (intracytoplasmic sperm injection).
• Transurethral resection of the ejaculatory ducts (TURED) – removal of obstruction to restore semen flow in men with ejaculatory duct obstruction.

Not all causes of male infertility can be treated surgically. Success rates will vary based on the underlying cause and the type of procedure performed. Male surgical procedures are most often combined with an assisted reproductive technology (ART) procedure for the female partner.