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Surgery for women

If you require surgery as part of your fertility treatment, either conventional open surgery or keyhole surgery may be offered.

Keyhole surgery - where possible, your clinic is likely to recommend keyhole surgery (laparoscopy) as this is a less invasive procedure and scarring is minimised. Keyhole surgery uses a 1cm cut in the umbilicus (tummy button) and two or three smaller cuts close to the pubic hair line. This type of surgery usually requires a general anaesthetic. 

Conventional surgery - usually uses a ‘bikini-line’ cut about 10 cm long. This type of surgery usually requires a general anaesthetic. A general anaesthetic is usually required. 

The HFEA does not regulate any type of surgery.


Is surgery for me?

When you first attend the fertility clinic, your medical history and examination may not give any clues as to the underlying cause of your infertility problem.  In this situation it is reasonable, at least initially, to give your pelvis the “benefit of the doubt” and defer any surgical investigation of the health of the pelvis.

On the other hand, your history and / or examination may indicate possible causes of your infertility that require investigation. For example:

  • If you have stated that there is pain superficially at penetration preventing satisfactory intercourse, examination may reveal that the entrance to the vagina is very tight and that full penetration has never occurred. 
  • Your periods may be becoming increasingly heavy and on examination the uterus is enlarged by a mass of fibroids.
  • Your periods have become heavy and painful and intercourse is painful on deep penetration. On examination a very tender thickened area can be felt at the top of the vagina highly suggestive of endometriosis.
  • You have a history of past pelvic surgery and on examination the uterus feels fixed in position instead of being able to be easily moved, suggesting the presence of adhesions.
  • You have had previous pregnancies with your partner ending in terminations. If you cannot now achieve a pregnancy with that partner, blocked fallopian tubes due to infection after the last termination may be the cause.

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Main procedures to investigate infertility

The main surgical procedures that are used to investigate infertility are:

Examination under anaesthesia - a thorough internal examination of the pelvis to inspect the vagina and cervix and to assess the size, shape, position and mobility of your uterus and ovaries

Hysteroscopy - to inspect the cavity of the uterus to exclude any fibroids, adhesions or developmental malformation like a septum (wall dividing the cavity of the uterus), all of which may prevent implantation of a pregnancy.

Laparoscopy and dye test - to inspect the entire pelvis through a laparoscope, to confirm that the tubes are open and healthy and to exclude the presence of endometriosis and adhesions.

Your clinic may recommend further surgery if:

  • your fallopian tubes are blocked
  • you have fibroids, mild endometriosis or another condition that affects the uterus, tubes or ovaries
  • you have polycystic ovary syndrome (PCOS) that has not responded to drug treatment
  • you have been surgically sterilised and want to reverse the procedure.

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How does the surgery work?

Where keyhole surgery is used, the usual initial steps are:

Step 1. Under general anaesthetic, the doctor makes a small cut just at the lower edge of your navel. 

Step 2. A telescope (called a laparoscope) is inserted to allow the surgeon to look at the affected areas.

Step 3. The next step then depends on the problem being treated.

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Surgery for women - Common surgical procedures

There are a number of types of surgery that are fairly common procedures for treating various fertility problems.

Read our list of these procedures and see what each involves:

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Page last updated: 29 September 2011

Who offers surgery?

To find HFEA-licensed clinics that offer surgery, Visit Choose a Fertility Clinic and look at any clinic's treatment and services page.