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Surgical Procedures for Infertility in Women

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The are two main types of surgical procedures for infertile women:

  • Assisted reproductive technologies
  • Procedures to correct anatomic abnormalities

Assisted Reproductive Technologies (ART)

ART is a general term used to describe several techniques that are used to establish a pregnancy without sexual intercourse. ART involves using human gametes (sperm and egg cells) in a lab to help with conception. The eggs and sperm can be from you and your partner or can be from a donor. The embryo formed from the egg and sperm can be implanted in your uterus or in the uterus of a surrogate woman.

ART methods include:

Artificial Insemination

Semen is collected and processed in a lab and then inserted directly into the woman’s cervix or uterus. The woman who is inseminated provides the egg, and fertilization takes place inside her body (usually in the fallopian tube). This procedure may be more successful if a woman is inseminated twice during her menstrual cycle (rather than just once). Artificial insemination is an option for couples who have:

  • A low sperm count or problems with sperm mobility
  • Problems with cervical mucus
  • Sexual dysfunction

The inseminated woman may be you (the prospective mother) or a surrogate mother. If you provide the eggs and your partner supplies the semen, the child will carry 100% of genes from you and your partner. However, if a surrogate woman is inseminated, the child will carry either 50% genes from your male partner and 50% from the surrogate mother, or 50% genes from a sperm donor (if used) and 50% genes from the surrogate mother. Genes are carried in the eggs and sperm to the next generation through conception. Whoever provides the egg and sperm determines the genetic makeup.

In Vitro Fertilization (IVF)

IVF proceeds in several stages. First, your ovaries are stimulated through hormone treatment to cause several eggs to mature instead of the usual one egg per month. When the eggs are considered mature, a long thin needle is inserted into your vagina. With the help of ultrasound, the needle is guided to your ovary and the eggs are collected. The entire harvesting procedure usually takes 10-20 minutes, depending on the number of eggs that are collected. In many centers, the procedure is performed with local anesthesia and mild sedation. You can usually leave the office after an hour or so of observation.

Once eggs are harvested, they are separated from the fluid that surrounds them and placed in an incubator where the environment can be precisely controlled. Next, the eggs are fertilized with sperm. This usually just involves preparing sperm from a semen specimen (produced by either your male partner or a sperm donor) and placing it in the same dish as the egg or eggs. After about 24 hours, the eggs are examined to see if they are changing in ways that indicate fertilization has occurred. In the next phase (anywhere from 2-5 days), fertilized eggs that have developed into multiple-cell embryos are drawn up into a plastic catheter that is passed through the cervix into the uterus, and the embryos are released into the uterus. Hormone therapy may continue for several days, and blood hormone levels will be monitored. A pregnancy test is usually performed within 12-14 days to determine whether an embryo has implanted and a pregnancy has begun.

In some cases, more embryos develop than should be introduced into the uterus for one pregnancy. These embryos can be frozen for an indefinite period of time through a process called cryopreservation. The frozen embryos can be thawed and transferred if the initial round of IVF is unsuccessful or if you want to have an additional child in the future. It should be noted, too, that IVF is often done with a donor egg and/or sperm.

There are several variations of the IVF procedure:

Gamete Intrafallopian Transfer (GIFT)

An egg is removed from your body and mixed with sperm in a laboratory. The egg and sperm mixture is then placed in your fallopian tube through a surgical procedure. The egg may be supplied by you or from an egg donor.

Zygote Intrafallopian Transfer (ZIFT)

An egg is removed from your body and mixed with sperm in a laboratory. The resulting embryo (2-3 days old) is then placed in your fallopian tube. The egg may be supplied by you or obtained from an egg donor.

Carrier Gestation (in a Surrogate Woman)

If you have eggs but do not have a functional uterus, you may supply eggs that are fertilized and placed in the uterus of a surrogate mother. If your male partner’s sperm is used to fertilize the eggs, the offspring will contain 100% of genes from you and your partner. If your male partner cannot provide the sperm, a donor can be used. If donor sperm is used, the child will have your genes but not your partner’s.

Women who do not have eggs and do not have a functional uterus may obtain eggs from a donor or surrogate. These eggs can be fertilized in vitro by your male partner’s sperm or that of a donor. They can then be transferred to the surrogate. Depending on the source of the sperm, the child will have either 50% of genes from your male partner or no genes from your partner. Because you did not supply the eggs, the child will not have your genes.

Procedures to Correct Anatomic Abnormalities

Many surgical procedures are available to correct anatomic abnormalities that may interfere with normal reproduction in women. These abnormalities include fallopian tube obstructions, endometriosis , uterine fibroids , or scarring of the ovaries or other pelvic tissues due to pelvic inflammatory disease (PID).

Laparoscopy and Laparotomy Microsurgery

Both of these procedures are frequently performed in outpatient settings.

Laparoscopy

Laparoscopy is done to examine, diagnose, and treat many of the causes of infertility . The surgeon cuts a small opening in the abdomen. The location of this incision varies depending on the procedure, either near the navel or in the lower abdomen for pelvic conditions. A needle is inserted and used to inject carbon dioxide gas into the abdomen. This gas causes the abdominal cavity to expand and makes it easier for the doctor to see the internal structures. The doctor inserts a long, thin tubular instrument (laparoscope) that lights, magnifies, and projects an image of the internal organs onto a video screen.

If necessary, several other tiny incisions may be made in the abdomen to insert instruments that can take biopsies (samples of tissue) or perform various types of surgery, such as removal of scar tissue, endometrial implants, or repair of blocked fallopian tubes. After the laparoscope and other instruments are removed, the incisions are closed with stitches or clips and covered with a dressing.

Laparotomy Microsurgery

Laparotomy microsurgery is similar to laparoscopy except that it requires magnification and thus allows very precise cutting and suturing.

Hysteroscopy

Hysteroscopy is a surgical procedure in which a small, lighted telescopic instrument (hysteroscope) is inserted through the vagina and the cervix into the uterus. The hysteroscope transmits an image of the uterine canal and cavity to a television monitor, which allows the surgeon to insert surgical instruments. This procedure is used to diagnose and treat numerous disorders, including abnormal bleeding, fibroids , and uterine polyps.

There are no surgical incisions with this procedure. After the cervix is dilated, the hysteroscope, which is a long, thin rod with a video camera and light attached to it, is guided through the cervix into the uterus. Carbon dioxide gas or fluid is also pumped into the uterus to inflate it. This frequently causes discomfort or cramping. After the surgeon visualizes the uterus, other surgical procedures can be performed, such as removal of scar tissue, adhesions, small fibroids and polyps, and intrauterine devices. Hysteroscopy is also used to diagnose uterine abnormalities that may be treated with another surgical procedure and may be performed in conjunction with laparoscopy.

Revision Information

  • American College of Obstetricians and Gynecologists. Diabetes and pregnancy. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org . Accessed July 2010.

  • American College of Surgeons website. Available at: http://www.facs.org .

  • Intrauterine insemination: IUI. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/infertility/iui.html . Updated May 2007. Accessed June 5, 2009.

  • International Council on Infertility Information Dissemination website. Available at: http://www.inciid.org .

  • RESOLVE: The National Infertility Association website. Available at: http://www.resolve.org .

  • 6/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Cantineau A, Heineman M, Cohlen B. Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples. Cochrane Database Syst Rev . 2009;(2):CD003854.