Explore Options for Fertility Surgeries

A doctor performs a hysteroscopy to look at the lining of your uterus with a viewing tool called a hysteroscope. The procedure is performed to find the cause of abnormal bleeding, to remove uterine growths like polyps and small fibroids, and to examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing repeated miscarriages. A hysteroscopy is both a diagnostic and therapeutic procedure.

A polyp is an overgrowth of the glandular surface of the endometrium. Polyps are often removed by hysteroscopic surgery to remove any impediments to implantation. Uterine polyps are found in up to 10% of women. Polyps can take up space within the uterine cavity, cause a zone of inflammation and can decrease pregnancy rates. Polyps may be single or multiple and measure between a few millimeters to several centimeters. The cause of uterine polyps is unknown but they seem to develop in response to the hormone estrogen. Most of the time they are asymptomatic, but some women who experience heavy menstrual bleeds, spotting in between menstrual periods or irregular menstrual bleeding may have polyps.

Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that uses a telescopic camera system to visualize abdominal and reproductive organs (uterus, fallopian tubes, and ovaries). The surgeon makes tiny incisions (approximately 0.5 to 1 cm) in the abdomen through which a thin, fiber-optic tube fitted with a light and camera is inserted. Suspicious growths can be biopsied and repairs can be made during a laparoscopy, making more invasive surgery unnecessary.

Fibroids are growths in or on the uterus which are almost always benign. They vary in size and grow inside the uterine cavity (where pregnancies develop), in the uterine muscle wall itself, or on the uterine surface. 

Between 30-40% of women have fibroids. Most uterine fibroids are asymptomatic and women do not even know they have them; they do not require treatment. In some women they can cause abnormal uterine bleeding, abdominal pain, pressure and sub-fertility. These cases are treated surgically with a myomectomy. There are several surgical options, including an abdominal myomectomy, hysteroscopic myomectomy, and laparoscopic myomectomy. 

Symptoms of fibroids include:

• Pain in the abdomen and back
• Difficulty with bowel movements and increased urination
• Sub-fertility and miscarriage

• Heavy bleeding with periods
• Increased pain with periods
• Spotting throughout the month
• Anemia or low blood counts

Most fibroids are diagnosed with transvaginal ultrasound. If your uterine fibroid is close to or protruding into your uterine cavity, your physician may have you obtain a hysterosalpingogram or a saline sonogram to better map out the relationship of your fibroids to the uterine cavity.

Myomectomy is a common treatment for uterine fibroids.

The uterus is left intact following a myomectomy, making it the preferred fibroid treatment for women who want to become pregnant. While a woman’s chances of becoming pregnant following myomectomy are improved, they are not guaranteed. Depending on the size and location of the myomectomy incisions, a Cesarean section may be needed for any future deliveries.

While Illume Fertility recognizes that tubal reversals are an option for women, we do not see it as the optimum way to manage a previous surgery that was meant to be permanent. In women who have had tubal ligations, we have found that the success rates of IVF and pregnancy far exceed the rate of pregnancy even after a so-called successful tubal ligation reversal.

Please consult with your physician or OB/GYN for additional information.

What are the myomectomy surgery options and recovery expectations?

Abdominal Myomectomy

This procedure removes fibroids through an incision on your abdomen. The incision is usually placed horizontally along the bikini line. This procedure is done in the hospital and most patients stay for 2-3 days before they go home.

At the time of the abdominal myomectomy, all detectable uterine fibroids are removed and the uterus is reconstructed. Oftentimes, a blue dye is placed in the cervix so that your doctor can make sure your fallopian tubes are open prior to performing your myomectomy.

Risks of abdominal myomectomy include:

1. Bleeding
2. Infection
3. Injury to other abdominal organs
4. Possibility of hysterectomy at the time of myomectomy (less than 1% of the time)

If after your surgery you experience fever, wound infection or abdominal pain, consult with your nurse or physician.

Abdominal Myomectomy Recovery Time

Most patients return to work within four weeks, although some may take six weeks to recover completely. Your physician may prescribe Lupron® or Cetrotide® prior to surgery. It is used to temporarily shrink fibroids, which will make your surgery easier and help build your blood count.

Hysteroscopic Myomectomy

Another way to remove fibroids is through a hysteroscopy. A hysteroscopic myomectomy is an outpatient procedure used to remove small protruding fibroids in the uterine cavity.

Fibroids that protrude more than 50% can be removed through the cervix using a resectoscope, a type of hysteroscope with a built in wire loop. This tiny loop can be placed in the uterus through the hysteroscope and allows your physician to remove a fibroid deep in the uterine wall by using high-frequency electrical energy to coagulate or cut the tissue.

Recovery Time for Hysteroscopic Myomectomy

This procedure is done in an operating room setting in a hospital or surgery center under local or general anesthesia. It is an outpatient procedure, so patients are discharged and go home the same day as surgery. Typically they can return to work the next day. Notify your nurse or physician if you experience fever or abdominal pain after your hysteroscopic myomectomy.

Laparoscopic Myomectomy

Performed through tiny external incisions using a fiber-optic camera, and often used for gynecological procedures.

Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) or superficial fibroids that are close to the outer surface of the uterus are the easiest to remove laparoscopically. However, fibroids that are growing deep in the uterine wall are difficult to remove through laparoscopy and are often candidates for abdominal myomectomy.