LAPAROSCOPY:

Description:

To search for and treat causes of infertility such as endometriosis or adhesions (scar tissue), an outpatient surgery called laparoscopy is offered. While under general anesthesia, a small incision is made in the umbilicus and a telescope less than half an inch in diameter is inserted. The surgeon inspects the reproductive tract for abnormalities. Treatment of abnormalities is performed immediately by using the laser or fine small instruments through additional small incisions in the lower abdomen. The Fallopian tubes are checked for openness by passing blue dye through them. Common laparoscopic procedures for infertility include laser vaporization of endometriosis; lysis of adhesions (removal of scar tissue); ovarian drilling; Fallopian tube repair; and removal of ovarian cysts. The procedure usually lasts less than an hour. After several hours of recovery in the post-operative suite, the patient is discharged home. Return to normal activities is expected after 3-7 days.

Indications:

If other causes of infertility are ruled out, laparoscopy is offered as the last diagnostic procedure in the basic workup. Laparoscopy is also recommended to diagnose pelvic pain, as well as to treat fibroids, ovarian cysts, and repair damaged Fallopian tubes.

Contraindications, complications, adverse effects:

As in any surgical procedure, complications may include bleeding, infection, injury to vital organs, and anesthesia risks. The cumulative risk of laparoscopy, however, does not exceed the risk of being involved in a motor vehicle accident. When performed by an experienced surgeon, major complications are very rare. Common adverse effects are abdominal discomfort, shoulder pain, nausea, and mild abdominal bruising. These usually dissipate in 2-3 days. Contraindications to laparoscopy include significant heart or lung disease, the presence of severe abdominal adhesions from previous surgery, certain bleeding disorders, and pregnancy.

HYSTEROSCOPY:

Description:

This is a procedure in which a thin telescope is placed into the uterus in order to diagnose and treat abnormalities. The cervix (mouth of the uterus) is dilated to accommodate the hysteroscope. Fluid or gas is introduced into the uterine cavity to distend it. If an abnormality is detected, treatment is often rendered immediately. Hysteroscopy may be performed in conjunction with laparoscopy or alone. It may be performed under general, regional, or local anesthesia.

Indications:

Hysteroscopy is often performed to diagnose and treat abnormal uterine bleeding. Endometrial polyps, uterine fibroids, scar tissue, and certain birth defects of the uterus can be treated by hysteroscopy.

Contraindications, complications, adverse effects:

Complications are rare and may include perforation of the uterus or other types of injury to the reproductive tract; excessive fluid absorption (leading to metabolic, heart, or breathing problems); bleeding, or infection. Common adverse effects are uterine bleeding and abdominal cramps. Contraindications to hysteroscopy include pregnancy, infection, certain cancers, and severe heart or lung compromise.