Laparoscopy for infertility
Laparoscopy is of great importance at the stage of diagnosing the causes of infertility and correcting the identified disorders. Many women come to see a reproductologist after only one or two diagnostic surgeries. That is why it is important to determine whether this procedure is necessary and to whom. It is important to understand what the doctor's goals are when sending a woman for laparoscopic diagnosis.
Indications for laparoscopic surgery before IVF:
Patency of the fallopian tubes
Tubal patency testing is performed in patients with a burdened gynecological history (IBD, ectopic pregnancies with preserved fallopian tubes, a history of myomectomy, frozen pregnancies, chronic pelvic pain, etc.), when, in addition to information about the tubes, the doctor needs to get an idea of the condition of the ovaries, uterus, severity of adhesions, prevalence endometriosis.
Hydrosalpinx
The presence of a hydrosalpinx is the only situation where there is no dispute about the need for surgery. Conservative treatment does not produce results, so the pathologically altered fallopian tube must be removed before the IVF program. This solution significantly increases the effectiveness of IVF programs and reduces the risk of complications during pregnancy.
External genital endometriosis
If we are talking about a patient with the possibility of natural conception, then laparoscopy really increases the chance of pregnancy. But when planning an IVF program, the need for surgery is questionable. When the patient's only complaint is infertility, laparoscopy to determine the presence and stage of endometriosis will not improve the prognosis.
Laparoscopy is indicated if the patient suffers from pelvic pain in addition to infertility. The choice of endometriosis treatment method is determined by the tasks facing a woman, whether it is achieving pregnancy, reducing pain, creating a normal menstrual cycle, normalizing sexual activity, and so on. In any case, it is better to first discuss in detail the need for surgery with a reproductologist.
Endometrioid ovarian cysts
According to all national guidelines (ASRM, ESHRE, RCOG), endometrioid cysts do not worsen the prognosis during IVF programs, do not increase the risk of complications during ovarian puncture and during pregnancy, and do not progress after stimulation. But ovarian resection before the IVF program significantly reduces the number of oocytes and embryos obtained, and therefore the likelihood of pregnancy. Therefore, in most cases, stimulation is performed against the background of endometrioid cysts, with rare exceptions (large size, poor access, pain syndrome).
Uterine fibroids
The difficult question remains, to remove or not to remove uterine fibroids before IVF. In the presence of submucosal fibroids (inside the uterine cavity) and deeper intracavitary nodes with deformity of the uterine cavity, it is necessary to remove these nodes using hysteroresectoscopy, often in combination with laparoscopy.
If there are "external" nodes on the uterus with a diameter of more than 4 cm, the effectiveness of IVF and pregnancy programs may decrease, which necessitates the removal of such fibroids by laparoscopic access (myomectomy).
For women who want to preserve their reproductive function, uterine artery embolization and focused ultrasound treatment (FUZ-ablation) are not indicated. In this case, according to the world literature, we can only talk about surgical removal of fibroids.
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Doctors
Keburija Lela
Ph.D. of Medical Sciences
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Desyatkova Nina
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Belousova Nadezhda
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Madan Korneliya
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Voznesenskaya-Tverdaya Juliya
Head of Clinic of reproductive and prenatal medicine at EMC
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Keburija Lela
Ph.D. of Medical Sciences
- Conducts the reception of patients with infertility, miscarriage, conducts all stages of ART programs
- Performs diagnostics and treatment of a full range of gynecological pathology (management of patients with endometriosis, uterine fibroids, polycystic ovarian syndrome, menstrual disorders)
- She graduated from the Russian National Research Medical University named after N.I. Pirogov with a degree in Medical Science and a residency in Obstetrics and Gynecology
Total experience
8 years
Experience in EMC
since 2023
