Which conditions affecting your fertility can be treated with surgery?
Blocked fallopian tubes
If you have only slight scarring or a potentially reversible blockage of the tubes (for example, you’ve previously had a sterilisation procedure) and your clinic has the expertise, surgery may be offered.
Scarring around the end of the fallopian tube can cause it to block with a watery fluid (hydrosalpinx). Unfortunately, in many cases the damage may be too severe to treat successfully. In these circumstances, doctors may recommend the fallopian tube is removed as this has been shown to improve the chance of successful IVF treatment. However, in milder cases, the blocked outer end of the tube is opened using keyhole surgery (a laparoscopy).
If you’ve previously had a sterilisation procedure that used clips to close the fallopian tubes, it may be possible for this to be reversed. This usually involves an open abdominal operation where the clips are removed and the tubes carefully repaired using an operating microscope.
Find out more about laparoscopy on the NHS Choices website.
Adhesions in the pelvis
If the ovaries are covered in fine adhesions from previous pelvic inflammation, eggs in the ovaries have no access to the open end of the fallopian tubes which means you won’t be able to get pregnant. It may be possible to remove all the adhesions (salpingo-oophorolysis) using keyhole surgery.
Polycystic ovary syndrome (PCOS)
Most women with PCOS who are not ovulating will receive drug treatment, but in circumstances where the woman requires a diagnostic operation (a laparoscopy), surgery may be suggested.. A procedure called ovarian drillinghas been shown to restore ovulation as effectively as medication.
Endometriosis is a condition where tissue identical to the lining of your uterus (womb) – the endometrium – grows outside the uterus. Each month it bleeds at the same time of your period, which can cause scarring, pain, and in some cases, cysts in your ovaries. If, during keyhole surgery, you’re found to have mild endometriosis with a few tiny deposits on the ovaries and pelvic ligaments, these may be destroyed at the time with a heated needle (electrodiathermy).
If the endometriosis is more extensive, involving other organs or significant cysts on your ovaries, you may be offered further surgery where the endometriotic tissue is removed, usually through laparoscopic surgery. The decision to operate will be made on an individual basis, taking into account the extent of the disease, where it is situated, and the impact surgery may have on you and your ovarian function.
Removal of fibroids
Fibroids are harmless (benign) growths of smooth muscle found in the uterus. Their position in the uterus will have an impact on a woman’s fertility, with those growing inside the uterus (submucosal) having the largest impact, and those growing on the outside (subserosal) having the least impact. It may be possible to shrink large fibroids with medication, taken over a period of up to six months. In most cases, this reduction in size is only temporary.
Fibroids can also be treated in a non surgical way called uterine artery embolisation, which can reduce both the symptoms and size of the fibroids. However, in general, significant fibroids thought to affect your fertility are removed surgically. This can be achieved with keyhole or open surgery.
If you have had large fibroids removed, leaving several scars in the uterus, you will probably be recommended to have an elective caesarean section, rather than giving birth naturally.
You can be treated for all these conditions on the NHS