Surgery to Improve Fertility

The desire to have children is very strong in many of us, and we go to great lengths to realize it. When can surgery help with this dream? And perhaps more important, when can it not?

Surgery remains an important step when the uterus has an abnormal shape. Women who have uterine fibroids, polyps or scarring inside the uterus, usually need to have these problems fixed before pregnancy will be successful. Surgery in these cases is highly effective.

Surgery can also be very effective for women who have had their tubes tied and want them untied. Not every method of tying tubes is reversible, but the most common types are, and are rewarded with pregnancy rates of over 60% with 2 years of trying. Women over age 37, who are running out of time to achieve pregnancy, should consider in vitro fertilization (IVF) instead.

In fact, in vitro fertilization, the "test tube baby" approach has made many surgical treatments for fertility outmoded. For instance, although very elaborate surgeries were devised years ago to fix tubes damaged by infections, they are rarely done these days. This is because the chance for pregnancy with one IVF try is much higher than after surgery. Women might expect a 40% chance for pregnancy in the month they try IVF, as compared to a 10 or 15% chance for pregnancy over a 2-year span of trying following surgery.

Another area where IVF is a better choice than surgery is for women with endometriosis. This is a strange but common condition in which the type of tissue that lines the inside of the uterus implants outside the uterus in the pelvic area. It can cause pain, and always seems to cause low fertility. While surgery can be a great help in dealing with the pain, surgery is of almost no use in improving fertility. And even women with the mildest degree of endometriosis remain subfertile when all the visible implants have been removed. This fact is not widely appreciated, even by many ob/gyn doctors. So if you have endometriosis, you need to consider additional help in achieving pregnancy besides surgery.

Surgery can usually help improve your chances for pregnancy if your uterus is deformed or if your tubes have been tied. But if your tubes have been damaged by infection or you have endometriosis, surgery does not help much and other methods are much more effective. Here at our centers we can help guide you to the most appropriate treatments, and as leaders in reproductive medicine, we can provide them all as well.