What is a laparoscopy?
Laparoscopy is a keyhole surgery used to assess abnormalities in the female reproductive organs: uterus, ovaries, fallopian tubes and other pelvic organs.
Patients could be recommended a laparoscopy due to pelvic pain, which is a characteristic symptom of gynaecological conditions. Although laparoscopy is not a routine step in first-line fertility evaluation, your fertility specialist may recommend it to investigate or improve problems that are making conception difficult.
Laparoscopy can be a useful diagnostic or therapeutic workup in fertility treatment, including:
- Diagnose and treat endometriosis
- Demonstrate tubal patency or problems
- Diagnose and correct uterine abnormalities
- Diagnose polycystic ovary syndrome
- Removal of pelvic adhesions, fibroids, cysts, tumours, scar tissues
- Treat ectopic pregnancies
- Treat pelvic inflammatory disease and other gynaecological problems
What does laparoscopy involve?
Laparoscopy is a day surgery that requires general anaesthesia. The procedure takes about one to two hours and most patients can recover in a few days.
To begin the surgery, you surgeon will make a small incision at or below the belly button. Carbon dioxide gas is used to inflate and lift the abdominal wall away from your internal organs. A laparoscope is then inserted into the abdomen to view your reproductive organs.
A video camera is fitted on the laparoscope and sends images onto a screen. Your surgeon uses the screen images to find signs of abnormalities and perform microsurgeries if necessary.
After the procedure, the incisions will be stitched up and you can go home the same day. During the next few days of recovery, you may experience symptoms including:
- Tiredness
- Muscle pain
- Mild nausea, pain or discomfort, cramps
- Minor vaginal discharge or bleeding
- Shoulder pain (due to the carbon dioxide gas)
Why is laparoscopy important in fertility treatment?
Many patients with fertility problems can benefit from a diagnostic or operative laparoscopy. The procedure allows your doctor to see if your fallopian tubes are open, whether you have any fibroids or endometrial tissues that could affect conception or pregnancy.
Although other non-invasive methods such as ultrasound or Hysterosalpingography (HSG) can also assess reproductive organs, laparoscopy is considered the “gold standard” for infertility assessment. For example, mild endometriosis, pelvic adhesions and scar tissues can only be identified using surgeries like laparoscopy.
In some cases, women who have normal HSG results could experience recurrent in-vitro fertilisation (IVF) failures. Laparoscopy has been shown effective in diagnosing unrecognised pelvic pathologies and improving the subsequent pregnancy rate1.
In subfertile women, laparoscopic microsurgeries could enhance natural conception by removing the adhesions or endometriosis that undermine fertility. In a case control study of 600 infertile women, 30% of the women who underwent laparoscopy achieved pregnancy within the next year2. The most notable outcome was noted in women with unexplained infertility (36.7% pregnancy rate in one year).
There is also evidence that laparoscopic tubal surgery prior to IVF can increase the pregnancy rate for hydrosalpinx. Similarly, removal of polyps and submucosal fibroids have been associated with increased pregnancy rates in subsequent intrauterine insemination3.
Summary
In summary, laparoscopy can be used as a diagnostic and operative tool in fertility treatment. Generally, laparoscopy is reserved for couples who have completed basic infertility evaluations through ovarian reserve, ultrasound, HSG and semen analysis. Laparoscopy has the potential to uncover reproductive problems not picked up by these methods. It may also help restore fertility in subfertile couples striving for natural or assisted conception.
References
- Yu, X., Cai, H., Guan, J., Zheng, X. & Han, H. Laparoscopic surgery: Any role in patients with unexplained infertility and failed in vitro fertilization cycles? Medicine (Baltimore) 98, e14957, doi:10.1097/MD.0000000000014957 (2019).
- Mahran, A., Abdelraheim, A. R., Eissa, A. & Gadelrab, M. Does laparoscopy still has a role in modern fertility practice? Int J Reprod Biomed (Yazd) 15, 787-794 (2017).
- Bosteels, J., Weyers, S., Mathieu, C., Mol, B. W. & D’Hooghe, T. The effectiveness of reproductive surgery in the treatment of female infertility: facts, views and vision. Facts Views Vis Obgyn 2, 232-252 (2010).