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How does a laparoscopy procedure help in evaluating infertility?

The laparoscopy procedure is a key hole surgery that provides a panoramic & magnified view of the pelvic organs. This medical procedure does not involve many risks and requires only a small incision. A laparoscopy procedure allows surgery at the time of diagnosis. In this blog by Dr. Manish Banker, let us understand the various health conditions for which a laparoscopy procedure can be done.
The laparoscopy surgeon makes a small cut of around 1-1.5 cm near the belly button after the anesthetists give general anaesthesia. A tube is inserted through the incision and gas is pumped through the tube to inflate the abdomen. A laparoscope is then inserted through this tube and it relays this image to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area. A further incision can be made if surgical treatment is required. The incision is closed with stitches or clips and a dressing can be applied. In a laparoscopy procedure, the surgeon can also collect biopsy samples.
Endoscopic reproductive surgery intended to improve fertility may include surgery on the uterus, ovaries, pelvic peritoneum [fatty curtain over the pelvic organ], and fallopian tubes.
Why is a laparoscopy procedure done?
There are various reasons why a laparoscopy procedure is done. Here are some of the reasons:

  • Tubal Patency- Laparoscopic surgeon performs this procedure to check tubal patency to get a good fertility outcome.

  • Adhesions- Laparoscopic procedures remain to be a useful and effective procedure for infertile couples with pelvic adhesions. Adhesion surrounding pelvic organs may have detrimental effects on fertility outcome so by means of laparoscopic procedures adhesions can be removed to have a good fertility outcome.

  • Hydrosalpinx- Hydrosalpinx is a chronic pathological condition of the fallopian tube, and it is one of the major causes of infertility. In most patients, the tube is distended with fluid. Laparoscopy procedure provides both:- a certain diagnosis and the treatment of hydrosalpinx at the same session. A positive impact on pregnancy rates is noticed in patients after laparoscopy.

  • Salpingectomy- Salpingectomy is a procedure performed by a laparoscopic surgeon on one or both fallopian tubes if it is found to be pathological. In case of blockage of the tube, we can use an additional method called hysteroscopic cannulation to remove the obstruction.
    Laparoscopic tuboplasty is a corrective procedure done on damaged tubes and It is a highly successful procedure. If the patient is young with good ovarian function, and good tubal condition, then high success rates are observed after laparoscopy. Overall 50% success rate is claimed in this procedure.

  • Laparoscopic myomectomy- Fibroids are the most common tumour of the female reproductive tract and affect 30-40% of reproductive-age women. Myomectomy for submucosal fibroids results in higher pregnancy rates. The removal of intramural/ subserosal fibroids shows a beneficial trend in increasing the chances of pregnancy. The marked reduction of adhesion formation by laparoscopy procedure gives it a distinct advantage over laparotomy, which is another common procedure.

  • EndometriosisFor moderate to severe endometriosis, surgery will improve chances of pregnancy after a laparoscopy. Large endometriomas may need to be removed surgically before IVF but smaller ones are generally best left in place. Surgery for very severe endometriosis or repeat surgery is generally not beneficial and may cause harm by reducing ovarian reserve and these patients better respond to ART.

  • Cystectomy- Laparoscopy surgery for benign ovarian tumours is associated with improved fertility outcomes.

Additionally, hysteroscopic guided biopsy and therapeutic procedures like polypectomy, septal resection, and adhesiolysis can be done in the same sitting by a laparoscopic surgeon.
To conclude, endoscopic surgery fulfils the important principles of gentle handling of tissue. The procedure is recommended as dissection of the skin is precise, leading to a very minimal skin incision. There are several reasons why laparoscopy procedures are performed, these are the main reasons. If you have any of these issues, do consult a fertility specialist such as Dr. Manish Banker, and understand all of your options.
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