At OBGYN matters we aim to carefully assess every woman and couple who are trying to conceive, to see what their chances are, and to work out if anything can be done to improve their chances of becoming pregnant.
We offer 30 minute appointments to take a detailed history and arrange appropriate investigations.
These tests include blood test, hormone tests, fertility tests such as Anti-Mullerian hormone, detailed Trans Vaginal Ultrasound, HyCosi and Antral Follicle count. We must also not forget to perform a Semenalysis!
Some women will then move forward to have a surgical assessment of their reproductive organs performed prior to considering IVF.
We feel that it is useful to consider an expert assessment and possibly the option of fertility surgery prior to commencing on the emotional ʻroller coasterʼ that is IVF. We work closely with local world class IVF centres.
Surgery takes the form of a Hysteroscopy (looking inside the womb) and a Laparoscopy (looking inside the abdomen to visualise the womb, fallopian tubes and ovaries).
Fertility surgery is usually performed using ʻkeyholeʼ surgical techniques as a planned ʻday caseʼ, as women usually feel well enough to go home on the day of their surgery and make a very quick full recovery. Day stay ʻkeyholeʼ surgery is so effective because most of the causes of infertility that are found, are small blockages of the fallopian tubes, adhesions, endometriosis, or abnormalities in the womb such as polyps, small fibroids or a septum.
These anatomical or physical abnormalities can be rectified using advanced surgical techniques that leave minimal scar tissue. A surgical division of adhesions, opening up of blocked fallopian tubes or removal of a small fibroid can have a profound effect on fertility and lead to a successful outcome without the need for further IVF treatment.
Most women want to maximize their chances of achieving a natural pregnancy and through advanced fertility surgery at OBGYN matters we hope to help them achieve this aim.
Fertility surgery can be offered for a range of problems
- Treatment of problems in the womb
- Surgery on the Fallopian tubes
- Treatment of Endometriosis
Infertility and Uterine Surgery
There are a number of ways in which problems in the womb may be the cause of infertility or reduced fertility. The most common of these are:
- Developmental abnormalities (uterine septum)
- Intrauterine adhesions
A uterine septum is a band of fibro-muscular tissue, which extends down the middle of the uterine cavity. It is the result an abnormality in the formation of the womb and is present from birth. Some uterine septae are small and do not affect fertilty. In other women they are large and may affect fertility or contribute towards miscarriage. If the patient has a history of infertility or miscarriage then the septum is probably best removed. At OBGYN Matters the surgery is performed by placing a telescope in the cavity of the womb and then vaporising or cutting the septum (operative hysteroscopy). We also perform a laparoscopy at the same time to avoid damaging the womb. We aim to excise or vaporise the septum during one operation but sometimes two or three operations may be required to get a perfect result.
In order to keep the cavity of the womb open we normally leave a coil within the cavity of the womb at the end of the procedure.
Many women have fibroids and these often donʼt affect fertility. They may cause problems if they are larger than 3cms, if they project into the cavity of the womb or if they compromise the fallopian tubes. They may be removed through the cervix or by laparoscopic or open surgery. Click here for more Info.
These are small fleshy overgrowths of the lining of the womb. They may be small or quite large (3cms) and project into the cavity of the womb. The bigger they are the more likely that they will cause problems with fertility. As they sit within the cavity they may interfere with implantation of the fertilised embryo and as a result they may cause problems both with natural fertility and with IVF treatment.
Fortunately, they are easily removed at Hysteroscopy following which they are sent for histopathology to check that there is no other reason for concern.
Adhesions with womb can occur after any damage to the lining of the womb. These typically occur after instrumentation of the womb for an incomplete miscarriage (ERPC) or after termination of pregnancy. They may also occur after a normal birth or a Caesarean section.
They are a significant cause for infertility in women who have had a previous pregnancy (secondary infertility). The adhesions may be thin and filmy (like a net curtain) and easy to divide. Unfortunately they may also be very thick and widespread (Ashermannʼs syndrome) in which case treatment may sadly not be so successful.
Surgery on the Fallopian tubes
The fallopian tubes may become scarred, caught up in adhesions or blocked and as a result women may be infertile or have reduced fertility. Tubal surgery was developed to overcome these problems. The surgery is usually carried out laparoscopically as the operating field is magnified, there is minimal tissue handling, the tissues do not dry out and very fine instruments and sutures may be used. All of these surgical techniques are important in minimizing the trauma of the surgery, optimizing results and speeding up recovery. Tubal surgery is particularly useful in mild disease at the ovarian end of the tube or where the tube is blocked right next to the womb.
Unfortunately, not all tubal disease is amenable to surgery and if the damage to the tubes is severe then it is important to consider that success rates from IVF may be superior. However, if the tubal disease is severe then surgery may still be helpful as there is evidence that the presence of the damaged fallopian tubes may reduce success rates of IVF treatment. In these cases or where the tubes are blown up with fluid (hydrosalpinges) then the fallopian tubes are probably best removed or clipped.
Treatment of endometriosis
Endometriosis is found in around 35% of infertile couples. There are many treatment options for this but surgery is probably the best. The success of treatment is very dependent on the severity of the disease. However, endometriosis can be excised or ablated with an impressive doubling of pregnancy rates even in moderate disease. If the endometriosis has caused scarring then this can be divided and normal pelvic anatomy can be restored and if there are cysts present then these can be removed to improve success rates of IVF.
Click for further information on endometriosis.
If as we hope, women are able to conceive following their surgery, than at OBGYN matters we are delighted to be able to offer a fully integrated service all the way from fertility surgery to antenatal care and delivery.