Infertility

Infertility is discussed in case when pregnancy does not occur after one year of regular intercourse without contraception. About 20 percent of couples are in this situation. Both women and men are equally affected by infertility. In women, the common cause of lack of pregnancy is ovulation disorders. They may be caused by polycystic ovary syndrome, thyroid disorders, hypopituitarism, hyperprolactinemia or excessive weight. Another common cause of infertility is obstruction of the fallopian tubes being a result of e.g., adhesions created after abdominal surgery, endometriosis, past inflammation. Sometimes the cause of lack of pregnancy cannot be established at all – then idiopathic infertility is discussed.

Laparoscopy has a leading role in the diagnosis and treatment of infertility. It is used in cases of infertility of unspecified reason or in the case of infertility with tubal or ovarian causes. If other causes of this problem have been ruled out first (endocrine disorders, genetic diseases), laparoscopy is a useful tool for evaluating the structure, location and patency of fallopian tubes, as well as the location of possible adhesions. In laparoscopy, it is possible to remove pathological changes causing infertility, as well as ovarian cautery – incision of the areola, which facilitates ovulation in the case of polycystic ovary syndrome in patients resistant to pharmacological stimulation. Laparoscopy is also a method which helps diagnose and treat malformations of internal genital organs.

Laparoscopic treatment for infertility requires specialist laparoscopic equipment and a well-prepared operating theater, but also a highly experienced and trained surgical team. It is a procedure that require particular precision of the operator so as to not to cause complications when manipulating micro tools in the patient planning pregnancy. The treatment is performed under general anesthesia on an operating table resembling a gynecological chair. It is bent so that the patient is in the so-called Trendelenburg’s position, i.e. with the head slightly lower than the legs. At the beginning of the procedure, carbon dioxide is administered to the abdominal cavity through a special needle in order to produce pneumoperitoneum. The gas lifts the abdominal wall upwards and “pushes” the bowel allowing the insertion of laparoscopic instruments. Next, through a small, approximately 10-millimeter cosmetic incision in the navel, a camera and a source of light are inserted into the abdomen.

A high-resolution, color image appears on the monitor at high magnification. Through three 5 millimeter incisions above the pubic symphysis, additional micro tools are inserted into the abdominal cavity. Any possible changes that could cause infertility are removed with their help. Sometimes, at the end of the procedure, a special anti-adhesion fluid is dripped into the abdomen. After finishing the procedure, tools from the abdomen are removed, and the previously inserted carbon dioxide is released. Cosmetic stitches are placed on wounds made from the inserted tools.

The patient is mobile about 4-6 hours after surgery. A few hours after the procedure, the patient may drink fluids, and after the occurrence of intestinal peristalsis, she may begin to eat easily digestible foods. The patient is sent home the next day after surgery. Because the pain after surgery is very small, only common analgesics are to be used. After surgery, it is possible to return to daily activities after 3 days and to full activity after about 7-10 days.