And sometimes faster is better.
When my female patients review their treatment options for their particular problem, the question most often on their minds is, “If I chose this treatment, when can I get pregnant?”
Every woman’s individual answer is shaped by the medical facts of her condition, her attitude and the advice of her fertility doctor. For some of the most common causes of infertility—endometriosis and fibroids—women have surgical options and often others, such as hormone therapy or fertility treatment such as IVF.
It’s not unusual for women to opt for the least invasive treatment option, at least at first. After all, “surgery” isn’t a word people take lightly. But in my experience, it’s often the best option to get a woman to “When can I get pregnant?” sooner and safely.
Cut out the bad actors
Literally. Common causes of infertility that are operable include:
- Endometriosis: An often painful disorder in which tissue that normally lines the inside of a woman’s uterus grows outside the uterus. Endometriosis affects up to 10 percent of females of reproductive age and is associated with difficulty conceiving. The decision to rely on surgery for endometriosis depends on many factors such as the presence of pain, the need to confirm the diagnosis, if the endometriosis is causing a cyst in the ovary that is large and growing, and if there is a desire to avoid IVF.
- Uterine fibroids: About 20-50 percent of reproductive age women have uterine fibroids, and roughly 10 percent of infertile women have them. Surgery for uterine fibroids also depends on multiple factors: if there is pain or abnormal bleeding, the size and location of the fibroids, and other fertility factors.
- Uterine polyps: Polyps are an overgrowth of tissue that lines the uterine cavity. If large, they can cause abnormal bleeding and be associated with inflammation making the uterine environment less receptive to an embryo for implantation.
- Dysfunctional Fallopian tubes: Blocked or damaged Fallopian tubes prevent sperm from reaching an egg to fertilize, prevent an embryo from reaching the uterus to implant, and can increase the risk of a tubal (etopic) pregnancy.
- Structural problems: An abnormally shaped uterus can prevent successful pregnancy. The most common congenital abnormality of the uterus is a septum and surgical correction of the septum improves the chances of conception and decreases the risk of miscarriage.
Of course, surgical options are not for every patient, either due to medical or personal reasons. And I thoroughly discuss with all my patients the facts and prospects of the different treatment options. Often, the least invasive options are not the best options.
Consider the case of the very common non-surgical treatment of hormonal therapy. If a woman is suffering from uterine fibroids, medication can only reduce the size of the fibroid. If a woman has endometriosis, medication can effectively treats pain but medication for endometriosis inhibits ovulation, so a woman cannot try to get pregnant while on the medication. It is just a temporary solution to a more problematic cause.
The quickest way to pregnancy
Laparoscopic surgery using the robotic da Vinci Surgical System is a minimally invasive procedure I perform that involves small incisions to the abdomen. These surgeries can help women with endometriosis, uterine fibroids, ovarian cysts, polyps and structural problems of the Fallopian tube, uterus and cervix. The benefits include:
- Better pain control
- Minimized blood loss
- Lower risk of infection
- Minimal scarring
- Faster recovery time.
Below are types of surgeries that I perform regularly. “Regularly” is an important qualifier in surgery. The more experienced the surgeon, the more likely he or she will recognize and skillfully remove all diseases, reducing the risk of recurrence and increasing the chance of better outcomes for patients.
This surgery for uterine fibroids is a step down from a hysterectomy, another surgery to treat complications from uterine fibroids that removes the uterus. In a myomectomy, I remove fibroids in the uterus, leaving it intact and ready for pregnancy.
A hysterectomy can resolve problems from endometriosis, but that’s not a good option for women trying to maintain their fertility. A resection surgery is. Resection involves removing the endometrial lesions and leaving the uterus, tubes and ovaries intact. Whenever possible, I use the da Vinci Surgical System for this procedure because endometriomas can be resectioned more completely, decreasing the risk of recurrence. In addition, suturing can be used instead of electrocoagulation (electrical method to stop bleeding), which can decrease the risk of destroying an ovary.
A diagnostic hysteroscopy identifies a problem. An operative hysteroscopy corrects the problem with surgery conducted through the hysteroscope, which gives the surgeon a clear view of the uterus’ lining. Operative hysteroscopy involves the use of small surgical instruments inserted through the hysteroscope to remove growths in the uterus, such as fibroids or polyps. Hysteroscopy can also correct uterine abnormalities such as adhesions or a uterine septum.