If you’re a woman facing infertility, a lot of times a surgical procedure will give you the best chance of conceiving. In addition, many women who are not infertile but want to preserve their fertility also need to have the kinds of surgeries done that a fertility surgeon routinely performs. If you are headed down this path, you must decide who should perform the surgery—probably the most important decision you’ll make in your fertility treatment journey.
A fertility surgeon is a better choice to perform a fertility-related surgical procedure than a regular surgeon. This is because fertility surgeons only perform fertility-preserving surgery and thus have more experience in this narrowly focused area.
The more of specific a procedure a surgeon has performed, the better the results tend to be. I can tell you that this is absolutely true for fertility surgeries, because I have done many of them. Not only does this give me a high level of confidence, which translates into everyone in the OR being more comfortable and focused, it also enables me to mentally reference past operations and apply that subtle insight to the woman on the OR table.
More training, more practice, more success
Fertility surgeons receive more advanced reproductive-specific surgical training than a regular reproductive endocrinologist infertility (REI) who offers surgeries. Additionally, a fertility surgeon will examine the big picture issue of fertility treatments for each case instead of just the current surgical plan. This should include a pre- and post-surgery fertility plan.
Fertility surgeons are going to be more in tune to new advances in fertility procedures because that’s their only focus. Here are some surgeries that you may be considering if you’re experiencing infertility, or conditions that fall under a fertility surgeon’s expertise, and why a fertility surgeon is better equipped to perform them.
Fallopian tube surgeries
The decision whether to try to save a damaged fallopian tube or not depends on where the blockage occurs and why the tube is blocked. Repairing a damaged fallopian tube has a low success rate but on the other hand, sometimes keeping a badly damaged tube decreases the overall chance of conceiving. Honest discussions with the patient before surgery about all the possible outcomes and consequences of different choices are important.
Laparoscopic surgery for endometriosis
Laparoscopy to remove lesions is one of the more common ways to treat endometriosis. It is less invasive than a traditional open surgery that requires large abdominal incisions. A fertility surgeon is a good choice for endometriosis surgery because she is going to look at the whole clinical picture, including ovarian reserve testing and testing the male partner. These factors are important in considering the risks and benefits of surgery.
For example, when a woman has an endometrioma (a cyst in the ovary caused by endometriosis) there are several things to consider in deciding whether it should be removed and how to remove it. Removing a cyst on the ovary can result in a decrease in ovarian reserve, so the surgeon needs to assess ovarian reserve before operating and determine if IVF may be the better option instead of surgery.
Surgical technique and approach can vary and fertility surgeons are aware of how different techniques can affect a woman’s fertility. For example, how the surgeon removes a cyst can affect ovarian reserve and chance of recurrence.
Myomectomy is the surgical removal of uterine fibroids that leaves the uterus intact, which is why it is the preferred method for women who wish to retain their fertility. A fertility surgeon will be focused on preserving the uterine cavity and minimizing any negative impact from surgery on the fallopian tubes. A laparoscopic myomectomy has a much lower risk of tubal scarring. Hysteroscopy as well as laparoscopy to treat uterine fibroids can be complimentary and sometimes both procedures are performed at the same time.
As one of the first fertility doctors and fertility surgeons in the Bay Area, I bring years of fertility-specific surgical experience to each case. My goal is to perform the best surgery you can possibly receive and to help you succeed in growing your family.
Fertility treatments require a great deal of courage, endurance and perseverance. But when the result is a child, it is well worth all the sacrifices. Surgery may not be the right choice for everyone and every case. But in many instances, a surgery provides the most efficient way to treat and provide the best chance for conception.