While surgery is not part of the typical infertility evaluation, diagnostic laparoscopy is regarded as the definitive test for evaluation of tubal factors and diagnosis of endometriosis. It allows for a thorough exploration of the pelvic organs (uterus, ovaries, fallopian tubes and peritoneal surfaces), determination if the fallopian tubes are open (patent), and confirmation of suspected pelvic adhesion (scar tissue) or endometriosis.
Repair of an abnormality can often be performed immediately. Repairs may include separation or removal of scar tissue (adhesions), tubal repair to re-open a blocked fallopian tube, destruction of endometrial implants, and removal or drainage of ovarian cysts. This is an outpatient procedure, usually performed under general anesthesia, and the woman goes home a few hours after the procedure.
Hysteroscopy is performed at the hospital or outpatient surgery center under IV sedation or general anesthesia for your comfort. It is a procedure to inspect the inside of the uterus (uterine cavity) using a small optical instrument inserted through the cervix. A liquid solution is used to distend the uterine cavity to facilitate its’ inspection. Abnormalities such a polyps, fibroids (submucosal) and scar tissue (adhesions) identified during the fertility evaluation (at the HSG or SIS) can be removed. A uterine septum can also be repaired via hysteroscopy. This wall or partition within the uterus is often associated with miscarriages and its removal can improve the pregnancy outcome.