Infertility surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief:  Sanjana Nethagani, M.B.B.S.[3]

#### Ovarian surgery

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* Laparoscopic ovarian drilling is done by performing multiple punctures in ovarian cysts by diathermy or laser. The main aim of this procedure is to reduce androgen levels and promote ovulation. This procedure might be pursued in clomiphene resistant women who also had hyperandrogemeia [1][2]
* Wedge resection is another therapy in PCOS when clomiphene therapy fails.
* Abdominal surgery to remove any virilizing tumors of the ovary or adrenal glands.

#### Tubal surgery

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* Salpingoovariolysis is done for peritubal adhesions.[3]
* Tubal block due to mucus plugging or any other reason can be corrected with salpingography or balloon tuboplasty.
* Distal tubal blocks such as fimbrial adhesions or fimbrial phimosis are treated with fimbrioplasty.
* Neosalpingotomy is the creation of a new tubal opening when a tubal block cannot be corrected.
* Mid-tubal block seen in surgical sterilization can be reversed to achieve fertility. How successful the surgery is in reversing the block depends on the method of sterilization, age of the patient, site of anastamosis and length of reconstructed tube. [3]
* Microsurgical procedures have the best results due to minimal scarring post surgery.
* Poor outcomes in tubal surgery are seen with dense adhesions, bilateral hydrosalpinx, advanced age, loss of fimbriae, short length of tube after reconstruction etc.

#### Uterovaginal surgery

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* Submucosal fibroids causing infertility can be corrected with myomectomy. Adhesions may be a complication post myometcomy.[4]
* Uterine septum removal or unification of a congenital septate uterus is done with metroplasty. [5]
* Hysteroscopic adhesiolysis is done in uterine synechiae.
* Hysteroscopic polypectomy is done to treat endometrial polyps.

## References

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1. ↑ Mitra S, Nayak PK, Agrawal S (2015). "Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome". J Nat Sci Biol Med. 6 (1): 40–8. doi:10.4103/0976-9668.149076. PMC 4367066. PMID 25810633.CS1 maint: Multiple names: authors list (link)
2. ↑ Tanaka Y, Tajima H, Sakuraba S, Shimokawa R, Kamei K (2011). "Renaissance of surgical recanalization for proximal fallopian tubal occlusion: falloposcopic tuboplasty as a promising therapeutic option in tubal infertility". J Minim Invasive Gynecol. 18 (5): 651–9. doi:10.1016/j.jmig.2011.06.014. PMID 21872171.CS1 maint: Multiple names: authors list (link)
3. ↑ 3.0 3.1 Gomel V, McComb PF (2006). "Microsurgery for tubal infertility". J Reprod Med. 51 (3): 177–84. PMID 16674012.
4. ↑ Rakotomahenina H, Rajaonarison J, Wong L, Brun JL (2017). "Myomectomy: technique and current indications". Minerva Ginecol. 69 (4): 357–369. doi:10.23736/S0026-4784.17.04073-4. PMID 28447445.CS1 maint: Multiple names: authors list (link)
5. ↑ Ferro J, Labarta E, Sanz C, Montoya P, Remohi J (2018). "Reproductive outcomes after hysteroscopic metroplasty for women with dysmorphic uterus and recurrent implantation failure". Facts Views Vis Obgyn. 10 (2): 63–68. PMC 6516190 Check `|pmc=` value (help). PMID 31110644.CS1 maint: Multiple names: authors list (link)

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