Operative surgery in infertility treatment

Operative surgery plays an important role in infertility treatment and in vitro fertilization. It is often believed that unsuccessful ET is connected to bad quality of embryo. In that case it is forgotten that there are three main factors that are relevant for becoming pregnant – embryo, uterus and body. In this article we focus on factors connected to uterus.

Which factors are considered to be important so that uterus would accept embryo(s)? These factors are correct structures and function of uterus and endometrial fluid.

Mostly the changes of uterus are connected to woman`s age. Women older than 35 years are more likely to have such changes in their uterus as myomas, adenomyosis, polyposis of endometrium or endometrial hyperplasia. Often these changes are caused by long term hormonal treatments during numerous unsuccessful IVF attempts and every change could be a factor impacting embryo implantation. Also chronic flammatory processes in uterus, fallopian tubes and in small pelvis may be the reasons why women cannot get pregnant.

Before operative treatment is put into practice there is a need to make certain that microflora of vagina is in normal range.

Operative surgery – hysteroscopy and laparoscopy :

 

There is used laparoscopic and hysterescopic surgery for operative treatment.

During hysterescopy it will be controlled if the uterine cavity is big enough, if there are abnormalties of uterus (for example septum of the uterus, bicornuate uterus), submucosal myomas of uterus, polyps, endometrial hyperplasia, adhesions and the changes are tried to be corrected.

During laparoscopy there will be controlled the possible changes of small pelvis. Mostly among infertile patients there are found lesions of endometriosis and removing those may reduce the impact of endometriosis on uterus and function of fallopian tubes and ovaries.
In case there is chronic inflammation in fallopian tubes and they have been operated before and the restoration of their function was not successful, removing the fallopian tubes that have such changes may increase the chances to become pregnant after embryo transplantation.

One of the reasons why embryo transplantations have not been successful may also be big, intramural and subserosally located myoma knots with a diameter 5 cm and more, they can be removed laparoscopically. Correction of adhesions in small pelvis may repair the function of organs.

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