Chapter 10

Laparoscopy - The Kinder Cut

Laparoscopy is a surgical procedure in which a telescope is inserted inside the abdomen through a small cut below the navel, so that the doctor can have a look at the pelvic organs in the infertile woman. A laparoscopy can lead to the diagnosis of many problems that cause infertility including damaged tubes, endometriosis, adhesions and tuberculosis.

When is laparoscopy done?

Most infertile women require diagnostic laparoscopy in order to complete their evaluation. Generally, the procedure is performed after the basic infertility tests, although the presence of pain or other problems (such as a history of previous surgery) may signal that a laparoscopy needs to be performed earlier during the workup. Most doctors will defer a Laparoscopy until the rest of your evaluation is completed, since it is a surgical procedure.

Timing the surgery

Some doctors will time the laparoscopy during the premenstrual phase (the week before the next period is due). They combine the laparoscopy with a dilatation and curettage (D & C) (scraping the inside of the uterine cavity) so that they can also get information on the woman's ovulatory status in the same procedure.

Some doctors try to perform the diagnostic laparoscopy during the periovulatory period (i.e., when the eggs are ripe, as judged by ultrasound) because such timing allows them to treat the infertility at the same by doing an intratubal insemination (also called SIFT or sperm intrafallopian transfer) in that cycle, if appropriate. This would be possible only if a previously done HSG showed that the tubes were normal.

Precautions before surgery

The patient is advised not to eat or drink anything for a specific time before the operation. Some tests may also be done before the procedure, to ensure safety for anesthesia, though for most young healthy women tests are usually not needed. Some doctors may want a HSG (hysterosalpingogram) done before performing a laparoscopy.The surgery is usually done on a day-care basis. Laparoscopy is done under general anesthesia so that the patient remains asleep during surgery and does not feel any discomfort.

Credits: How to Have a Baby: Overcoming Infertility