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    • 07 JUL 15

    “Laparoscopy, hysteroscopy and fluoroscopy, oh my!” by Julian Escobar, M.D., Reproductive Endocrinologist and Infertility Specialist


    If you are trying to conceive a baby and it’s not happening as quickly as you expected, you may wonder if you have an infertility issue. According to the American Society for Reproductive Medicine, you should seek the care of a specialist if you are unable to achieve pregnancy after 12 months of unprotected intercourse. If you are over the age of 35, the time to seek a specialist is reduced to six months. Today, there are several innovative tests and procedures we can do to help pinpoint possible causes of your infertility—and increase your chances of achieving a successful pregnancy.


    Infertility in a nutshell.

    Infertility is a disease of the reproductive system. About one third of infertility can be attributed to female factors, and about one-third can be attributed to male factors. Other cases are due to a combination of problems in both partners or to unknown causes.


    Male factor problems include structural, movement and sperm production disorders. Evaluation of the male partner is essential for the diagnosis and timely treatment of specific causes of male factor infertility. Almost every male fertility issue can be overcome with today’s treatments.


    Problems with ovulation (egg production) account for most infertility issues in women. In some cases, the woman never releases eggs, while in others the woman does not release eggs during some cycles. Without ovulation, eggs are not available to be fertilized.


    Several other health issues can also lead to infertility in women. If the fallopian tubes are blocked, for example, the egg and sperm cannot meet and fertilization will not occur. Blocked fallopian tubes may result from previous pelvic infections, endometriosis, or pelvic surgery.


    Is reproductive surgery right for you?

    Although in vitro fertilization (IVF) offers the best chance of becoming pregnant in any given cycle, surgery is very useful for investigating and treating a variety of reproductive problems. When infertility is the result of a physical blockage or abnormality within the uterine cavity and/or fallopian tubes that prevent conception or implantation, advanced reproductive surgery may be recommended.


    Many reproductive surgeries can be done on an outpatient basis using minimally invasive techniques, which utilize specialized instruments, miniature cameras and high-definition monitors to perform the procedures through tiny incisions or natural openings, such as the cervix. The benefits include less pain, less blood loss, smaller scars (if any), and a faster recovery.


    Surgery choices.

    Here are some of the more common surgical procedures available today.



    A hysteroscopy is a minimally invasive surgical technique that allows a surgeon to examine and perform procedures on the inside of the uterus. When performed for fertility treatment, it may involve the removal of uterine fibroids, polyps, scars or the correction of congenital malformations.


    While the patient is under anesthesia, the cervix is dilated, allowing for the insertion of a thin surgical device – known as a hysteroscope – into the uterine cavity. A camera on the end of the hysteroscope makes it possible for the doctor to examine the uterus. Sterile saline is used to gently distend the uterus, making it easier to see and access the areas to be treated. Specialized instruments are then used to perform the necessary fertility treatment procedure. Since no incisions are necessary, there are no stitches to be removed and recovery time tends to be often as short as a day.



    While hysteroscopy involves the examination and treatment of the inside of the uterus, laparoscopy is performed to assess or treat problems in the pelvic cavity, outside of the uterus. Laparoscopy can be performed for the treatment of endometriosis, pelvic scarring and other conditions.


    By creating one or more tiny incisions in the abdomen, the surgeon can insert a laparoscope equipped with a small camera on the end of it into the pelvic cavity. The space is inflated with carbon dioxide gas. Additional instruments are then introduced in order to perform the procedure. Once the fertility treatment surgery has been completed, the abdomen is deflated and the incisions are closed. The healing process lasts a few days only.


    Tubal cannulation with fluoroscopy

    Selective tubal cannulation is a minimally invasive procedure to help clear a blockage in the fallopian tubes, which is one of the most common causes of female infertility. It is less invasive than conventional “open” surgery, and it may help your doctor better understand why the blockage occurred.


    For this procedure, the doctor inserts a small tube called a catheter through the cervix and into the endometrial cavity with the aid of a hysteroscope. Fluoroscopy, or continuous X-ray imaging of the fallopian tubes, is used to guide the surgeon to the correct area. The blocked area in the fallopian tube is opened up using a balloon on the catheter or with the X-ray wire itself.


    Tubal cannulation may be done immediately after a procedure called salpingography. During this procedure, dye is first flushed through the catheter to identify and locate a fallopian tube blockage. The recovery time is only a day.


    Realize your dream of growing a family!

    Infertility is a medical condition that can often be treated. As many as 50 percent or more of couples who seek an infertility evaluation will respond to treatments and will achieve a successful pregnancy. If you are concerned about how long it is taking you to get pregnant, it may be time to take a different approach. Talk to an infertility specialist to discuss your options, based on your age, reproductive health and other circumstances.