Laparoscopy for Infertility

Understanding Causes of Infertility Treatable By Laparoscopy And What Is Involved

Laparoscopy for infertility is the use of a tiny tube with a camera, magnifying glass, and light source fitted at its tip to take a look at the abdominal and pelvic cavity to investigate and treat causes of infertility. It is done through a small cut on the skin of the abdomen.

Infertility is a cause of great emotional and psychological pain.

Laparoscopy for Infertility Takes A Look At The Whole Of The Female Reproductive System.

The sense of loss and bereavement experienced by couples seeking to have a child of their own is easily not understood by many onlookers.

Exactly.

Bereavement is not only when you lose someone dear to you. It is also that strong sense of loss from being deprived of someone or something so dear to you. If you are seeking to have a baby of your own, is that not how you feel?

Are you currently undergoing tests for infertility? You may want to know the common causes of infertility, conditions that are possible to be investigated by laparoscopy and exactly what laparoscopy for infertility involves. 

You may also want to know what treatment options are available, as well as what the treatment does to bring about improvement in fertility.

Infertility Defined

Infertility is the inability to achieve conception after 12 months of regular unprotected sexual intercourse in a man and woman.

You should be having unprotected penetrative sex about 3 times a week for a year to be said to have had an optimum chance to conceive.

Most women would achieve conception (70%) with optimal sexual intercourse within 6 months. Nearly all women (84%) would become pregnant at 12 months of optimal sexual intercourse. At two years of trying for a baby, 92% of women would achieve conception and this figure does not improve much here after.

Women are most fertile within the ages of 20 to 24 years and the best age to be pregnant is believed to be 23 years. 

Ability to conceive reduces steadily in women after the age of 35. In terms of fertility for men, age does not significantly matter, though fertility decreases slightly with advancing age.

Common Causes Of Infertility

If you are struggling to conceive, it is important to remember that it takes two to conceive. It is important to look for the possible causes of this problem in both the man and the woman.

Each of you would share about the same level of risk of causes of infertility. You must work together. Less pressure and no blame helps a great deal. The following are common causes of infertility in both the man and woman.

Causes of Infertility In Men

Too busy a life style.

  • Is your man always traveling, in a high pressured job and lacks time for proper and regular sexual intercourse?
  • Is there something that can be done to improve this?
  • Regular unprotected sexual intercourse about three times a week is advised.
  • Too much of everything is bad too. Some women have been known to insist of sex everyday and several times a day to help achieve conception. Well, the sperm needs time to form and mature.
  • The answer is for both of you to work out what is best for both of you around what is advised here. 

Poor Sperm Count.

  • Low or abnormal sperm count is the most common cause of infertility in 1 out of 5 cases of infertility.
  • This may be due to job - eg being a lorry driver
  • Over weight or obese
  • Excessive alcohol intake,
  • Smoking excessively (cigarettes or marijuana),
  • Taking body building or anabolic steroids or
  • Due to mumps, chronic gonorrhea or chlamydia infections.
  • Other causes could also include the presence of undescended testes and varicocele.

Causes of Infertility In Women

  • Absent Or Irregular Ovulation. This could be due to PCOS, Turner's syndrome or other hormonal imbalances
  • Excessive weight loss (if your BMI is less than 19, it would be difficult conceive)
  • Hyperprolactinaemia - causing milk to be secreted from the breast even when you don't have a baby that is breast feeding
  • Blocked Fallopian Tube - this could be following a pelvic inflammatory disease or chronic chlamydia or gonorrhoea infection
  • Adhesions
  • Endometriosis
  • Fibroid
  • Hostile Cervical Mucus and presence of anti-sperm antibodies
  • Kallman's syndrome
  • Unexplained causes

Tests For Infertility

The tests for infertility is often started by doctors, with taking a very careful and detailed history from you and your partner. Ideally, both of you should be seen by the doctor. Once the menstrual history, and other history is established, the following are the common tests done to try and understand why you are not achieving conception:

  • Examination of the man and woman.
  • Day 21 progesterone test. This is a blood test done to check if the woman is actually ovulating; you can not make babies without releasing eggs or ovulating. A blood progesterone level of 30nmol / L or more indicates that the woman is ovulating.
  • Sperm or Semen Analysis. Once the 21 Day Progesterone test comes back to be good, the next test for infertility is doing a semen analysis to see what the sperm count and quality of the sperm is.
  • Hysterosalpingiogram. This is a test to check the lumen or patency of the uterus and the fallopian tubes. It is also called the dye test. A dye is injected through the cervix or neck of teh womb into the womb and an x-ray is taken, to show if it spills out from the ends of the tubes on the sides of the womb. If there is blockade from previous infection, or endometriosis or adhesion, or polyp or any other cause, no dye will be seen at the outer end of the tubes.
  • Laparoscopy. This is the use of a laparoscope (which is a tiny tube fitted with a camera, telescope and light source at its end), to look inside the organs in the abdomen. The laparoscope is introduced into the abdominal cavity through a small cut on the abdomen. This is done under general anesthesia.
    The whole of the abdomen and pelvis is inspected for presence of any of the causes of infertility treatable by laparoscopy.
  • Sperm-Cervical Mucus Compatibility Test. If all the above tests for infertility come back normal, your doctor may then want to do a test for the compatibility of the sperm and mucus of the couple. Sometimes, antibodies are produced by the mucus secreted by the woman that destroys the perms. This is done by taking a sample of mucus from the neck of the womb 6 to 12 hours after intercourse at about the middle of the woman's cycle. The mucus taken is then spread out on a small glass slide and examined under the microscope to see if there are many actively swimming sperms inside the mucus.

Use of Laparoscopy In Infertility

Laparoscopy is used in infertility either as a tool to investigate the cause of infertility, or as a treatment modality. Often, it is used both for investigation and treatment. Once the cause of fertility problem is identified during the investigation, treatment can be administered during the same time.

Laparoscopy for infertility is done for only a number of conditions that are amenable  to diagnosis and treatment by this means.  They include:

1. Adhesion

  • These are strong spider web-like bands that results from healing inside the abdomen and pelvis following a previous operation.
  • They can also occur naturally in a few individuals.
  • They cause the surfaces of organs to stick to one another or to the wall of the abdomen.
  • They are a common cause of infertility by causing blockade of the fallopian tube
  • They can also be caused by endometriosis.
  • They can be cleared off by means of laparoscopy and improve the chance of conception in a procedure known as adhesiolysis.

2. Endometriosis

  • Endometriosis is the deposition of a functional layer of the lining of the inner wall of the womb outside the womb. 
  • Endometriosis leads to impaired fertilization by causing a distortion in the normal anatomy of the female reproductive system, inhibits the capture of the egg or ovum released during ovulation by the fallopian tube where fertilization takes place, as well as reduce the reception of the fertilized egg if this happens, by the womb.
  • Laparoscopy for infertility when endometriosis is involve, has been shown to greatly improve the chance of conception in mild to moderate endometriosis.
  • Because the debris and clotted blood associated with endometriosis can block the fallopian tube, flushing of fallopian tube during laparoscopy improves pregnancy rate in procedure known as salpingolysis.

3. Blocked tubes

  • Blocked tubes could result from adhesion, endometriosis, but also following a chronic pelvic inflammatory disease
  • Previous infections with gonorrhea, chlamydia or other sexually transmitted diseases are a common cause of tubal blockade.
  • Laparoscopy combined with hysteroscopy is effective in the investigation and treatment of this condition to aid fertility in some women. 
  • Cuff salpingostomy can be done to repair a blocked segment of the fallopian tube. So too is another laparosopy for infertility procedure called cornual re-anastomosis.

4. Fibroid

  • Fibroids are "womb stones" or onion-like growth found in the wall, surface or covering of the womb. They very rarely cause infertility, if they happen to block both fallopian tube entrance into the womb. 
  • Laparoscopic surgery can be used to remove any such fibroid that may be causing infertility if present.
  • If a fibroid is not in the way and not causing any problem, they are best left alone.

5. Tubal polyps

A polyp is a finger-like growth that can occur inside the wall of the fallopian tube, causing obstruction. Endoscopy may be able to demonstrate this and surgery could be done to unblock the tube and bring about improved chance of conceiving.

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