A good option for some women to get pregnant is surgery. There are many different kinds of procedures that can repair problems that may be causing infertility. Other procedures are to look for problems that might lead to miscarriage or to treat conditions to enhance fertility.
One very common procedure is Laparoscopy or keyhole surgery. At times laparoscopy cannot solve the problem and open surgery (laparotomy) will be needed. Sometimes these surgical treatment cannot get you pregnant on their own, but are required to improve your chance of pregnancy with IUI or IVF.
Some medical conditions require specific types of surgery. Hysteroscopy is a way of looking at the inside of the womb with a camera. Surgery to remove polyps can often be performed this way.
The different surgical procedures will have variable success rates depending on the condition and unique features for each woman or couple.
Endometriosis
Surgical treatment of endometriosis can increase the chances of getting pregnant. Medical treatments given for the pain associated with endometriosis (such as the birth control pill, GnRH agnost injections, Danazol etc) all prevent pregnancy or can cause abnormalities in babies and so should not be used in women trying to get pregnant. If the endometriosis is severe, especially when egg levels are low on AMH testing, the tubes are blocked or the ovaries damaged, IVF is advised as a better option.
Blocked tubes
Sometimes surgery to relieve the blockage is undertaken. Results depend upon the severity of the blockage but are generally poor, so IVF is often recommended. If the egg levels are low or if the male partner also has a sperm problem then surgery is not recommended due to very low success rates.
Adhesions or pelvic scar tissue
If tubes are open and the ovaries are working normally, then key hole surgery (laparoscopy) may reveal adhesions (scar tissure). This scar tissue can also be removed, when it is only present in minor or average levels, during the laparoscopy.
Fibroids
If fibroids are either large (over 8cm in diameter) or situated close to or inside the womb lining, then surgical removal is usually recommended.
Asherman syndrome (scar tissue inside the womb lining)
Removal of the scar tissue via hysteroscopy (telescope surgery inside the womb) can be performed. The procedure requires a short general anaesthetic. If this does not result in pregnancy the only option may be surrogacy, in which the sperm of the male partner is implanted into the womb of another woman who carries the baby throughout pregnancy.
Endometrial polyps
These are non-cancerous small growths in the lining of the womb. They are likely to reduce pregnancy rates and will usually require removal by hysteroscopy before fertility treatments start.
PCOS
Not everyone with PCOS will respond to fertility drugs (link to ovulation induction treatment) and grow eggs. Another treatment to help the ovaries to grow and release eggs is the procedure of “ovarian drilling” performed using laparoscopy.
During this minor operation, each ovary is punctured several times. This can result in the eggs spontaneously releasing in the 12 months following the surgery. In some cases, drugs to help the eggs grow and release may need to be used again if a pregnancy has not occurred after a certain number of months.
Laparoscopic ovarian drilling should not be used in women not currently trying for a pregnancy as it causes some irreversible damage to the ovaries and loss of eggs. It is usually recommended only once or twice in a woman’s lifetime. It is never performed in young women who do not wish a pregnancy. It also does not cure PCOS and there are better treatments for the common symptoms of PCOS.