Surgical Procedures for Infertility in Women
by Cynthia M. Johnson, MA
Surgery may be an option for some women with infertility. It can:
Procedures to Fix Certain Problems
Some problems can make pregnancy hard or impossible. Surgery may fix these problems. It may be an option for:
Laparoscopy and Laparotomy Microsurgery
Laparoscopyis done through small cuts in the belly. The cuts may be around the belly button or lower. Recovery time is often shorter compared to open surgery with a large incision.
A scope is passed through the cuts. It has a light and a camera that will send images to a screen in the room. The images will be used to guide the doctor. Other tools will be passed through the openings. They can be used to take out scar tissue, place implants, or repair blocked tubes. It may also be used to find what may be causing problems. When the surgery is done, the cuts will be closed with stitches or clips. A dressing will be placed over the area.
Laparotomy microsurgery is like the laparoscopy. This option uses a larger cut in the belly. The surgeon will also use a special microscope to see the organs.
A hysteroscopy may be used to treat abnormal bleeding, fibroids, uterine polyps or more. It doesn't need cuts in the belly. The scope and tools will be passed from the vagina through the cervix and into the uterus. It sends pictures to a screen in the room. The doctor will use it to view the organs. Tools can also be passed with the scope to do some work. The doctor will be able to remove scar tissue, adhesions, small fibroids, and polyps. Devices can also be placed in the uterus. It may also be used to diagnose problems.
Assisted Reproductive Technologies (ART)
ART is done to start a pregnancy without sex. The egg and sperm can be from you and your partner or can be from a donor.
ART methods are:
Semen is collected. The sample is treated in a lab and then placed into the cervix or uterus. The egg is fertilized in the body. It may be more successful if it is done twice during a menstrual cycle instead of once. Artificial insemination is an option for couples who have:
Sperm may be placed inside the vagina or uterus of the woman. The baby will have the genetics of the mother and father (or sperm donor). If the sperm is used in a surrogate mother, then the baby with have genetic material from the father (or sperm donor) and surrogate or from the mother and father.
In Vitro Fertilization (IVF)
IVF is done over several stages. First, hormone treatments will be used to mature eggs in the ovaries. The eggs will be removed when they are ready. The doctor will use a long thin needle. It will be passed through the vagina. An ultrasound will help guide the needle to the right spot. The mature eggs will be pulled through the needle. It usually takes 10 to 20 minutes. Anesthesia may be used to numb the area.
The eggs will be prepared in a lab. They will then be placed in an incubator. The temperature and humidity can be controlled there. Next, sperm is placed in the same dish. The eggs are checked after 24 hours. If they were fertilized, then certain changes will have happened. In two to five days, fertilized eggs will grow into multiple-cell embryos. The embryos are drawn up into a plastic tube. The tube will be used to release the embryo in the uterus. Hormone therapy may done for several days. Blood hormone levels will be watched. A pregnancy test is usually done within 12 to 14 days. This will show if an embryo has implanted and a pregnancy has begun.
Sometimes more embryos grow in the lab than should be placed into the uterus. They embryos can be frozen and kept. The process is called cryopreservation. The frozen embryos can be thawed and used for later rounds of IVF. The eggs and sperm may be donated or they may come from the intended parents.
There are several types of the IVF procedure:
Gamete Intrafallopian Transfer (GIFT)
An egg is taken from the body. It is mixed with sperm in a lab. The egg and sperm mix is then placed into the fallopian tubes. The egg is not yet fertilized.
Zygote Intrafallopian Transfer (ZIFT)
An egg is taken from the body. It is mixed with sperm in a lab. The egg will be watched until it is fertilized and an embryo forms. The embryo is then placed in your fallopian tube instead of the uterus.
Carrier Gestation (in a Surrogate Woman)
A pregnancy may not be possible if the uterus doesn't work well. Eggs may be taken from the mother. They will be mixed with sperm and placed into a surrogate.
Sometimes the egg will need to come from a donor. The implant will follow the same steps with donated egg and sperm. In either option, sperm may come from a partner or be donated.
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Last reviewed December 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG
Last Updated: 1/2/2019
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