When infertility is caused by anatomical problems, all but the most severe cases can usually be corrected surgically. The cause of infertility can sometimes be traced to previous infections or inflammation that left scarring. Endometriosis, fibroids, and other uterine abnormalities can also be treated with surgical techniques.
An Operative Hysteroscopy is a visual examination of the interior of the uterus to look for tumors, scars, or abnormalities. This procedure is performed on an outpatient basis under general anesthesia. The cervix will be dilated to allow the hysteroscope to be inserted through the vagina and cervix into the uterus. To make viewing easier, the cavity is inflated with a small amount of carbon dioxide. If needed, small sterile instruments are then inserted into the uterus through the hysteroscope to perform any corrections. Some common findings may be polyps, fibroids, adhesions or uterine septums.
In addition to the Operative Hysteroscopy, a Laparoscopy may also performed. This procedure is also performed on an outpatient basis with the use of general anesthesia. An instrument is passed into the abdomen through a tiny incision below the navel. A second instrument is inserted through an incision at the pubic hairline. The cavity is inflated with a small amount of carbon dioxide to make viewing easier. This procedure gives a direct view of the uterus, ovaries, fallopian tubes and pelvic cavity, allowing for detection of any scar tissue. It may help to identify endometriosis, which is the presence of normal uterine tissue in abnormal places outside the uterus.
A Laparotomy/Myomectomy is performed for the removal of large fibroids. During a laparotomy, an incision is made in the abdomen for removal of the fibroid(s). The uterine wall is then repaired to help prevent pelvic adhesions or scarring, while the uterus is left alone, for future fertility. This procedure is major abdominal surgery and is done as an inpatient surgery in the hospital. One can expect to be in the hospital for 2-3 days, with a total recovery time of 4-6 weeks.