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Surgery for women

Certain conditions affecting a woman’s fertility such as endometriosis, fibroids and blocked fallopian tubes can be treated with surgery. Find out more about the different types of surgery and which conditions it can be used to treat.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Doctor placing samples into a centrifuge

You can be treated for all of these conditions on the NHS

Which conditions affecting your fertility can be treated with surgery?

Blocked fallopian tubes

If you have only slight scarring or a reversible blockage of the tubes and your clinic has the expertise, a type of surgery (salpingostomy) may be offered. This is where the blocked outer end of the tube is opened using keyhole surgery (a laparoscopy) or an open abdominal operation.

Find out more about laparoscopy on the NHS Choices website.

Adhesions on the ovaries

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)

Some women with PCOS will receive drug treatment but it’s also possible to have surgery. The advantage of having surgery is that it does not increase your risk of having a multiple birth.

Find out more about the risks of a multiple birth

In a procedure called ovarian drilling, a heated needle (electrodiathermy) is used to destroy some of the extra follicles (the sacs in which eggs develop) which are producing an excess of male hormones.

Mild endometriosis

If during keyhole surgery you’re found to have a few tiny deposits of the ovaries and pelvic ligaments, these may be destroyed at the time with a heated needle (electrodiathermy).

If the endometriosis is more extensive, you may be offered further surgery where the endometriotic tissue is removed, usually through microsurgery or by laser surgery.

Removal of fibroids

It’s possible to shrink large fibroids with drugs taken over a long period of time. However it is generally felt that significant fibroids thought to affect your fertility should be surgically removed. This can be achieved with keyhole or open surgery. 

If you have had large fibroids removed, leaving several scars in the uterus, you’ll be recommended to have a caesarean section when giving birth.

Is surgery for me?

When you first attend your clinic it might not be clear what the underlying cause of your infertility is. Rather than having invasive surgery immediately, it’s reasonable to assume your pelvis is healthy unless your medical history suggests otherwise. This could include:

  • If you’ve experienced pain at penetration which has prevented full sexual intercourse. Examinations may show that the entrance to the vagina is very tight and full penetration has never occurred.
  • If your periods have become increasingly heavy. This could mean the uterus is enlarged by fibroids.
  • If 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 which could be endometriosis.
  • If you’ve had pelvic surgery in the past and on examination the uterus feels fixed in position instead of being able to be easily moved, suggesting the presence of adhesions.
  • If you’ve had previous pregnancies with your partner ending in terminations. If you can’t now get pregnant with that partner, blocked fallopian tubes due to infection after the last termination may be the cause.  
Couple standing under an umbrella

"When both my fallopian tubes were found to be blocked I was told I had virtually no chance of conceiving naturally, which was devastating."

Read Saskia's story

Couple read together in a field

"Our wedding day felt like a bit of a strange anti-climax. When other couples might start trying for a family we thought ‘okay, now what?'"

Read Claire's story

What tests might I have if I have a potential surgical problem?

You may have one of the following examinations:

Examination under anaesthesia: this is 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: this inspects the cavity of the uterus to see if there are any fibroids, adhesions or developmental malformations like a septum (wall dividing the cavity of the uterus), all of which may prevent the embryo from implanting.

Laparoscopy and dye test: used to inspect the entire pelvis to confirm that the tubes are open and healthy and check if there’s any endometriosis or adhesions.

What are the different types of surgery?

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 which produces less scarring than with conventional surgery. Keyhole surgery uses a 1cm cut in the belly button (umbilicus) 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.

Find out more about the different types of surgery from the Royal College of Surgeons. 

After surgery will we need to have IVF or can we try to conceive naturally?

It really depends on how serious your condition was and what was involved. Women who have surgical treatment for endometriosis may well conceive naturally, provided their tubes are clear. 

If fibroids are removed women would usually attempt to conceive naturally, unless there are other problems. Fibroids tend to impact on implantation and pregnancy, and in vitro fertilisation (IVF) doesn't deal with this. Anyone with serious fibroids would need to have them dealt with before attempting IVF. 

Patients who have ovarian drilling for PCOS may also conceive naturally if there are no other problems.

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Review date: 24 May 2019