Center for Infertility and Reproductive Surgery

Endometriosis

• What is Endometriosis?
  Endometriosis is the presence of endometrium (the lining of the uterus which is shed monthly) outside of the uterus. Implants of endometriosis commonly occur behind the uterus and on and near the ovaries. Endometriosis may be associated with adhesions (scarring) or endometriomas (endometriosis cysts in the ovaries).
  
  
• Endometriosis Symptoms
  
  • Pelvic or abdominal pain
    
  • Pressure or fullness in the pelvis
    
  • Menstrual cramps
    
  • Pain with intercourse
    
  • Infertility
    
    
• Endometriosis Treatment
  
  • Medical
    
    • Birth control pills
      
    • Danazol
      
    • Gonadotropin releasing hormone agonist (Lupron, Synarel)
      
    • Progestins (Norethindrone, Provera)
      
  • Surgical
    
    • Laparoscopy (day surgery)
      
    • Laparotomy (more extensive surgery)
      
    • Hysteroscopy
      
      

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Ovarian Cysts

• What are Ovarian Cysts?
  Ovarian cysts are fluid filled cavities within the ovary. Each month fluid collects around the developing egg forming a follicle. After ovulation the follicle becomes a corpus luteum which makes progesterone. Either a follicle or a corpus luteum can form a cyst (follicular or corpus luteum cysts). There are also benign (non cancerous) and rarely (cancerous) cysts which can form in the ovary.
  
  
• Ovarian Cyst Symptoms
  
  • Often asymptomatic
    
  • Pelvic pain
    
  • Pelvic pressure
    
  • Abdominal enlargement
    
  • Bowel or bladder symptoms
    
    
• Ovarian Cyst Treatment
  
  • Expectant (may go away without treatment)
    
  • Surgical (Generally as complicated as day surgical procedures)
    
    • Cystectomy (removal of cyst)
    • Oophorectomy (removal of ovary)
      
      

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Fibroids

• What are uterine fibroids?
  Uterine leiomyomas, commonly known as uterine fibroids, are well-circumscribed, non-cancerous tumors arising from the myometrium (smooth muscle layer) of the uterus. Other names for these fibroid tumors include fibromyomas, fibromas, myofibromas, and myomas. Fibroid tumors are the most common solid pelvic tumor in women, causing symptoms in approximately 25% of reproductive age women. However, with careful pathologic inspection of the uterus, the overall prevalence of fibroids increases to over 70%, because leiomyomas can be present but not symptomatic in many women.
  
  
• Symptoms of Uterine Fibroids
  
  • Abnormal uterine bleeding, often menorrhagia (prolonged and/or profuse uterine bleeding, with periods lasting over 7 days)
  • Pelvic pressure, resulting from an enlarged uterus.
  • Irregularly shaped uterus (having many lumps and bumps) which may put pressure on the bowel and/or bladder. Can result in difficulty with bowel movements and constipation or urinary frequency and incontinence. Rarely, fibroids can press on the ureters which can lead to kidney dysfunction.
    
  • Reproductive dysfunction including recurrent miscarriage, infertility, premature labor, fetal malpresentations, and complications of labor
    
    
• Uterine Fibroid Therapies/Treatments: World-Reknowned Care
  Therapy for Uterine Fibroids and Endometriosis Internationally recognized as a pioneer in the development of non-surgical therapy for uterine fibroids and endometriosis, the Center also offers a variety of minimally invasive treatment options for these conditions. (For more information visit the Center for Uterine Fibroids.)
  
  

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Tubal Ligation Reversal (TLR)

• What is Tubal Ligation Reversal (TLR)?
  Women who have had their tubes tied (ligated) either by laparoscopy or at the time of their last delivery have an option of having their tubes untied (reanastomosed), through surgical intervention.
  
  
• Surgical option
  
  • Laparoscopic TLR (day surgery, small incision, quick recovery)
    
  • TLR through laparotomy (6 inch incision, 1-2 day hospital stay, 3-6 weeks recovery period)
    
    
• Tubal Ligation Reversal Screen Rates
  
  • 50-85% successful pregnancy
    
  • Success depends on woman’s age, type of tubal ligation performed and length of remaining healthy tube(s).
    
    
• Tubal Ligation Reversal Costs: $8,000-$15,000, usually not covered by insurance.
  
  

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Recurrent Pregnancy Loss

This evaluation and management program focuses on all aspects of treatment, including medical, surgical and psychological care. Internationally respected, the program has helped thousands of women, who have repeatedly lost pregnancies, build healthy families.

• What is it?
  Recurrent pregnancy loss refers to the loss of miscarriage of 2 or more consecutive pregnancies. This can occur at any stage in the first 20 weeks of pregnancy.
  
  
• Causes
  
  • Hormonal imbalance
    
  • Uterine problems
    
  • Genetic
    
  • Immunologic
    
  • Excessive blood clotting in the placenta
    
    
• Treatment
  
  • Correction of hormonal problems
    
  • Surgical treatment of uterine abnormalities (e.g., malformations, fibroids)
    
  • Preimplantation genetic diagnosis (PGD)
    
  • Immunologic treatments
    
  • Blood thinners
    

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Reproductive Surgery

Minimally Invasive Surgery
Laparoscopic and hysteroscopic procedures are among the options available
to treat various reproductive disorders, including:

• tubal reconstruction, repair and tubal-ligation reversal
  
• repair and reconstruction of intrauterine abnormalities
  
• removal of endometrial tissue due to dysfunctional bleeding that is not responsive to medical therapy
  
• uterine fibroids
  

Most procedures, including the latest in laser surgery, are performed
on an outpatient basis.

• What is it?
  Benign and malignant pathology affecting the reproductive tract can cause clinical symptoms and challenge a woman’s ability to initiate and maintain a pregnancy. Gynecologic surgery specifically aimed at restoring or maintaining reproductive function is called reproductive surgery. Among gynecologic surgeons, those who specialize in reproductive endocrinology and infertility are specifically trained to be attentive to a woman’s future reproductive needs. Reproductive surgeons are specifically skilled at minimally invasive surgical techniques such as laparoscopy and hysteroscopy, and consistently adopt the principles of microsurgical technique to minimize any negative impact of surgery on reproduction.
  
  The skills of reproductive surgeons may extend to procedures not necessarily aimed at maintaining reproductive function, but allow the procedures to be undertaken in a minimally invasive day-surgery setting. This is the case for example for laparoscopic hysterectomy or oophorectomy.
  
  
• Indications:
  
  • Endometriosis
    
  • Ovarian cysts
    
  • Ectopic pregnancy
    
  • Pelvic adhesions
    
  • Regret of tubal sterilization
    
  • Congenital malformations
    
  • Uterine fibroids
    
  • Uterine polyps
    
    
• Treatments:
  
  • Laparoscopic or laparotomic excision of endometriosis
    
  • Laparoscopic management of ectopic pregnancy
    
  • Laparoscopic excision of ovarian cysts
    
  • Laparoscopic lysis of pelvic adhesions
    
  • Laparoscopic reversal of tubal sterilization
    
  • Laparoscopic or laparotomic excision of fibroids (myomectomy)
    
  • Hysteroscopic excision of fibroids (myomectomy)
    
  • Hysteroscopic excision of polyps (polypectomy)
    
  • Hysteroscopic lysis of uterine adhesions
    
  • Hysteroscopic correction of uterine malformations