As your fertility doctor, we will conduct an examination and take a thorough health history, and then discuss potential treatment options with you. We understand how important your reproductive health is, and we want to ensure that every option is considered in your treatment plan.
However, sometimes our patients require surgery. At the WCWRC, we offer several surgical treatment options for your individual needs, at surgery centers that suit your individual circumstances, preferences, budget and insurance.
Surgical Treatment Options
Uterine issues are quite common, and can often be successfully corrected with surgery.
Common uterine problems include uterine fibroids (non-cancerous growths in the uterus), and endometrial polyps (overgrowths of cells in the lining of the uterus). Another possible condition is adenomyosis, where the glands from the inside of the uterus (endometrium) grow down into the uterine muscle.
Less common are abnormalities, that occurred from birth, which can affect the reproductive organs. These include a duplicated uterine cavity. With a bicornuate or didelphic uterus, the two uterine cavities are separated by muscle. This may affect pregnancy outcomes, but is not usually surgically corrected as it’s less likely to be associated with infertility or miscarriage. If the division in the uterine cavity is avascular (fibrous tissue only), it is called a septum. The presence of a septum seems to markedly increase the percentage of miscarriages. This septum can be removed during an outpatient septum surgery.
For many uterine issues, we often use a hysteroscopy: a procedure where a thin, lighted tube is inserted to see inside the uterus. In addition our trained physicians can perform a laparoscopy or laparotomy to remove the leiomyomas/fibroids in order to help restore your fertility and increase your chances for conception.
Ovarian Cyst Surgery
Ovarian cysts are very common in women, and most resolve spontaneously without the need for any medical or surgical intervention.
Most cysts are just physiology gone awry. For instance, a follicle may not rupture as it should to release an egg during ovulation, and instead will continue to grow into a cyst. These types of cysts most often resolve themselves spontaneously. However, occasionally a cyst is a growth rather than a follicle or egg house. Examples include a endometriomas (old blood filled cysts lined with endometrial like cells), a dermoid cyst (a growth which may have oil, hair, teeth and nail tissue), a benign (non-cancerous) simple tumor, or a malignant (cancerous) tumor.
We cannot biopsy these cysts non-surgically, so ovarian cyst removal is done if the cyst is persistent or suspicious-looking. For young women who want to maintain their fertility, ovarian cystectomies are performed, either using the laparoscope (through small holes in the abdomen) or a laparotomy (via an incision similar to a C-section). Laparoscopy enables patients to recover quickly from surgery and return home the same day.
We understand how frustrating persistent ovarian cysts can be and will work with you to determine the best course of action to help you with your fertility goals.
Fibroids are an extremely common problem in women. Some studies estimate than 70-80% of women will be diagnosed with a myoma in their lifetime. Not all myomas need surgical removal, only those with symptoms.
Polyps are extremely common in women. These small growths of connective tissue and endometrial tissue can possibly interfere with the implantation of an embryo in the uterus, contribute to miscarriages, cause irregular bleeding and may also be at the root of other fertility issues. The good news is that they can easily be removed.
Polyps are typically removed through a hysteroscopy. A telescope is inserted through the cervix into the uterine cavity and the polyp is removed with scissors, a cutting current or a mechanical morcellator, thereby increasing the chances for a successful pregnancy in the future.
In female fetuses, the uterus actually develops from two separate uteri that eventually meet in the midline to become one uterus. In some women, this process didn’t completely finish while they were developing, and their uteri didn’t fuse together as was intended. Sometimes this results in a woman presenting as having one uterus on the outside, but there are two cavities on the inside. The cavities may be divided by muscle (bicornuate) or by avascular fibrous tissue (septum).
Since a septum can increase the risk of miscarriage, septum surgery is needed. Using a hysteroscope, a doctor can cut the septum and successfully create one endometrial uterine cavity.
Other rare congenital abnormalities include having two cervixes and two uteri (complete didelphys), having one cervix but two separate uteri, or one cervix and one half-uterus (unicornuate). In all of the above cases, it’s important to be evaluated by our fertility specialists to see what treatment options are available to you to help ensure a healthy pregnancy.
Tubal surgery has been the traditional treatment of choice to diagnose and repair fallopian tube abnormalities. However, surgery has limited success for all but mild tubal issues.
Doctors opt for tubal surgery rarely these days, since IVF is a much better alternative treatment for tubal disease, with better success rates — especially for diseased tubes. On the other hand, if fallopian tubes have been “tied” for sterilization, a patient may prefer tubal reversal because it has high success rates and allows for spontaneous conception without the use of hormones, although the success rates vary based on maternal age.
If surgery is needed to repair damaged or diseased tubes, then it is recommended to cut any scar tissue, burn any endometriosis, and generally try to improve the health of the pelvis. If one tube is closed and dilated (hydrosalpinx), removal of that tube may improve pregnancy rates, both naturally and with IVF. If both tubes are blocked, it may be necessary to remove both tubes. Repair of a damaged tube allows for the possibility of a spontaneous conception, but can be associated with an increased risk of a pregnancy in that tube (ectopic pregnancy).
Our experienced doctors are committed to helping you reach your fertility goals. We will do a thorough examination to help determine the health of your fallopian tubes, and design a custom treatment plan should an issue be found.
Fertility Doctor Tina Koopersmith
Discusses Infertility Surgical Treatments
Together We’ll Find A Way
Our experienced fertility doctors will evaluate your specific situation and individual fertility, and guide you through the process to determine the best course of action to reach your fertility goals.
We look forward to meeting you, learning about you, and helping you to be healthy and happy. To schedule an appointment you can call the West Coast Women’s Reproductive Center at (818) 616-9277 or make an appointment online.