The Role of Laparoscopy in IVF

Couples faced with infertility are often advised to undergo assistive reproductive therapies, and are counseled to undergo in-vitro fertilization. However, not every patient can afford IVF or even want to undergo an IVF cycle to become pregnant.

Additionally, after a failed IVF cycle, the patient faces an important decision: whether to attempt another expensive cycle of IVF, or explore other options. Laparoscopy may offer these patients something to hope for. And since laparoscopy is available in the Philippines, IVF success may be a reality for couples looking to start a family.

Laparoscopy is an outpatient surgical procedure usually performed under general anesthesia. They can be performed in outpatient surgical clinics, or in a traditional hospital setting. During a laparoscopic procedure, the surgeon makes a small incision near the umbilicus (navel) and fills the abdomen using carbon dioxide gas with a Veres needle to create pneumoperitoneum. After that, a trocar—an instrument with a pencil-sized diameter—is then passed through the incision, allowing the flexible fiber optic laparoscope to be passed into the abdomen.

With the laparoscope, reproductive structures such as uterus, fallopian tubes, and ovaries can be inspected directly and in real-time. The surgeon can also inspect for abnormalities in the appendix and upper abdomen. Small incisions can be made in the suprapubic area, just along the hairline above the pubic bone to accommodate additional instruments. to handle tissue, blood and other fluids as needed. Any findings such as ovarian cysts, endometriomas, and even disorders of the fallopian tubes can be corrected.

When visualizing the fallopian tubes, the physician injects a blue dye into the uterine cavity to determine their patency. Any blockage of the fallopian tubes can be corrected during laparoscopy. Some physicians insert a slightly larger scope through the umbilical port, which allows them to use a carbon dioxide laser to perform adhesiolysis (cut scar tissue) or treat endometriosis.

Endometriosis is a disorder where endometrial tissue that lines the uterus spreads to areas within not only a woman’s pelvic cavity, but also her abdomen. The fallopian tubes are most commonly affected, as well as the ovaries and intestines. Up to 50 percent of women dealing with infertility are also afflicted with endometriosis. Laparoscopic treatment for endometriosis has been documented to increase the pregnancy rate as high as 65 percent.

For many years, all women who were seeking fertility care underwent laparoscopy as part of the initial evaluation. These days, patients are willing to undergo hormonal treatments, artificial insemination, and in-vitro fertilization while avoiding evaluation or treatment for endometriosis. This suggests that women dealing with infertility or even a failed IVF cycle may have undiagnosed endometriosis.

A retrospective study was conducted on 29 patients who had failed IVF treatments and were offered laparoscopic evaluation and treatment instead of additional IVF cycles and other options. All subjects were found to have endometriosis, and over 22 were able to conceive after completing laparoscopic treatment.