What is infertility?

Infertility is generally defined as the inability to conceive after one year of unprotected intercourse, or after six months in women over age 35.

Who is affected by infertility?

An estimated 6.7 million women in the U.S. have an impaired ability to get pregnant or carry a baby to term. (1)

What conditions can affect a woman’s chances of getting pregnant and carrying a baby to term?

Infertility can be a problem for any woman. Although there are many factors that increase a woman’s risk of infertility, it is estimated that 40 percent of infertility problems are due to a gynecological condition that can be treated with corrective surgery. The following are a few common causes.

• Uterine polyps are excess growths of tissue in the lining (endometrium) of the uterus. Many polyps are very small and don’t affect a woman’s reproductive ability but large polyps – or multiple polyps – can interfere. It is thought that uterine polyps cause infertility by disrupting the lining of the uterus and interfere with implantation of a fertilized egg.
• Fibroids affect 80 percent of all women. They are non-cancerous tumors, made of muscle tissue, that can occur anywhere in the uterus and grow either as a single tumor or in clusters. One specific type of fibroid, called submucosal fibroids, are located just beneath the outer layer of the uterus and are especially associated with lower implantation rates, lower pregnancy rates, and increased rates of miscarriage.
• Endometriosis affects about one-half of women with infertility. This condition occurs when the endometrial cells, or uterine lining cells, exist outside of the uterus. Endometriosis often impedes reproduction by causing pelvic adhesions that prevent conception or through the formation of endometriomas, a type of cyst formed when endometrial tissue grows in the ovaries and disrupts the function of the ovaries. It is also thought that the inflammatory fluid caused by endometriosis impairs sperm and tubal functions, resulting in infertility.

Other GYN problems that can cause infertility are pelvic adhesions, an abnormality called a uterine septum, which essentially divides the uterus in half, and hydrosalpinx, a fluid filled fallopian tube.

• In the case of pelvic adhesions, which is a type of scar tissue, if they surround the ovary, the ability of an egg to reach the tube after ovulation may be limited. Adhesions of the tube can prevent the sperm from reaching the egg, or an embryo from reaching the uterus.
• Uterine septum is a type of congenital malformation where the uterine cavity has a wedge-like wall at the top of the uterus, which protrudes into uterine cavity. Women with a uterine septum are at a significantly higher risk for miscarriage and infertility. It is thought that the septum is a poor environment for an embryo to implant in because of the poor blood supply.
• Hydrosalpinx is a malformation that can block or distort the fallopian tubes, causing infertility or an ectopic pregnancy.

What infertility surgery options can improve my chances of getting pregnant naturally or through IVF?

Uterine polyps, submucosal fibroids, intrauterine adhesions, and uterine septum can be removed through a surgical procedure that uses a hysteroscope, a small, thin telescope-like camera that is inserted into the uterus. Moreover, pelvic adhesions removed with minimally invasive laparoscopic surgery restores the natural shape of the pelvic organs and removes barriers to conception.

In the case of endometriosis, resection or excision of endometriosis can be performed to preserve the uterus, tubes and ovaries and improve a woman’s chance of getting pregnant.

A minimally invasive myomectomy technique, such as LAAM, can be performed to remove fibroids while keeping all reproductive organs in tact.

How effective is surgical treatment in improving a woman’s chance of getting pregnant?

Many studies have been conducted to determine the connection between endometriosis and fertility. For example, a large Canadian study that showed significantly increased pregnancy rates after surgical treatment, even among women with mild endometriosis. Women who had their endometriosis treated had a pregnancy rate of 31 percent versus only 18 percent in the untreated group. An additional study on the effects of fibroids from the Journal of the American Association of Gynecologic Laparoscopists found that removing fibroids from women who were infertile increased the pregnancy rate from 25 percent to 42 percent. (2)