Some cases of infertility in both men and women can be helped with surgery.
Sterilisation can sometimes be reversed: fallopian tubes can be unblocked using keyhole surgery and, for men who cannot produce sperm (if they have had a vasectomy, or a failed vasectomy reversal), sperm can be retrieved surgically for use in fertility treatment.
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.
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.
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.
Surgery for men
Surgery may be an option for men who want to reverse a vasectomy or who cannot produce sperm naturally.
Is surgery for me?
Your clinic may recommend surgery if:
a very large collection of varicose veins around the vas warrant removal or tying off
a testicular biopsy is advised to investigate a confirmed zero sperm count
you have had a vasectomy and want to reverse the procedure
you have had a failed vasectomy reversal
you do not ejaculate sperm but there is evidence of a low level of sperm production within the testicles.