Surgery can be performed to increase the likelihood of a successful pregnancy. Such surgeries are including, but not limited to: removal of uterine fibroids, polyps, septums, and scar tissue that involve the endometrial cavity. These surgeries are done by hysteroscopy. Hysteroscopy is a minimally invasive, outpatient surgery, where a long narrow camera is inserted vaginally into the uterus. It does not involve an incision. Polyps, fibroids, and uterine cavity scar tissue can easily and safely be removed through the hysteroscope.
Other reproductive surgeries include surgeries to remove endometriosis implants and scar tissue in the pelvic cavity. This can be done by laparoscopy. Laparoscopy is a minimally invasive outpatient surgery in which a laparoscope (a narrow instrument with a camera lens) is inserted into the pelvic cavity so that diagnosis and/or treatment of fertility problems can occur. Pelvic surgery is typically reserved for indications of pain and masses. With the advent of invitro fertilization and its high success rates, often it is recommended for highest pregnancy rates, to proceed straight to in vitro fertilization in women who have known significant pelvic endometriosis or scar tissue women and bypass surgery.
Myomectomy refers to a surgical procedure in which uterine fibroids (muscle balls) are removed from the uterus. Fibroids only need to be removed if they are causing pain, pressure, or bleeding problems. Fibroids that involve the uterine cavity and not just the uterine musculature are recommended to be removed if future fertility is desired.
Tubal reanastomosis surgery involves microscopically reconnecting the fallopian tubes after they have been ligated. Over 90% of the time, 1 or 2 of the fallopian tubes can be successfully reconnected. Subsequent monthly pregnancy rates are dependent on the age of the woman. Ectopic pregnancy rate after tubal reanastomosis is approximately 4-10% of pregnancies. Again, with the advent of in vitro fertilization and its high success rates, it is often recommended to proceed straight to in vitro fertilization in women who are status post tubal ligation.