Some women have difficulty conceiving because of problems in their reproductive system. These range from a congenital malformation (birth defect) of the uterus or absence of a vagina, to acquired abnormalities such as polyps, fibroids or endometriosis.
If such a condition is found during your comprehensive fertility evaluation, you may need surgery to correct the problem. Some of the surgical procedures available to UCSF patients are described below.
Hysteroscopy is a procedure in which a small, telescope-like instrument is inserted directly into the uterine cavity. The scope allows the surgeon to visualize the uterine cavity and to diagnose conditions such as uterine septum — protrusion of the upper wall of the uterus into the cavity — scar tissue, uterine polyps, endometriosis or uterine fibroids.
Depending upon the severity of the condition, this procedure can be performed either in our offices or in the operating room. Hysteroscopy allows diagnosis and, most often, resolution of the anatomical problem. This is an outpatient surgery, and it does not require an overnight stay.
Laparoscopy allows doctors to view and assess the pelvic organs. During the procedure, a small, telescope-like instrument is inserted through the belly button, with additional small instruments placed strategically through the abdominal wall. Some of the conditions that may be found with laparoscopy include endometriosis, tubal damage, hydrosalpinx (a fluid-filled fallopian tube), scar tissue, uterine fibroids, ovarian cysts and tumors.
Laparoscopy is an outpatient procedure and often, the surgeon can correct the problem at the same time it is being assessed. Before surgery, an ultrasound examination is used to define any potential defects.
In laparotomy, an abdominal incision is made to allow access into the abdominal and pelvic cavities. Typically, this procedure requires a longer recovery time because the incision is made through the muscles and the fascia protecting the abdominal and pelvic organs. Sometimes, however, the surgeon is able to perform a mini-laparotomy involving a much smaller incision, and the patient may leave after a short observation period.
Laparotomy allows surgeons to deal with larger pelvic problems, such as uterine fibroids, extremely large ovarian cysts, or a ruptured ectopic pregnancy with uncontrolled hemorrhage. The decision to proceed with a laparotomy will be discussed in detail before a planned surgery, so the patient understands the risks and benefits of the proposed procedure.
Reviewed by health care specialists at UCSF Medical Center.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
Center for Reproductive Health
2356 Sutter St., Seventh Floor
San Francisco, CA 94115
Phone: (415) 353-7475
Fax: (415) 353-7744