Why it is not a good idea to have laparoscopic surgery before doing IVF
Many infertile women have fibroids and endometriosis. These are extremely common findings in all women in the reproductive age group ; and we'll see them in fertile women as well, so it's not very surprising that we find see them in infertile.
Many infertile women have fibroids and endometriosis. These are extremely common findings in all women in the reproductive age group ; and we'll see them in fertile women as well, so it's not very surprising that we find see them in infertile. Now, when a gynecologist sees fibroids and endometriosis in an infertile woman, even if plans to refer this patient for IVF, he will often advise endoscopic surgery to remove the fibroid ;as well as treat the endometriosis. The logic behind this is that removing the endometriosis will help to "cleanup the pelvis " and therefore increase the chances of embryo implantation. Many gynecologists explain to patients that fibroids can grow during pregnancy, and can cause a miscarriage ; which is why it's good idea to remove them before actually starting the IVF cycle.
It's very common to see these interventions in patients who been referred to me, partly because modern ultrasound technology has become so good. The resolution of the new machines is very good and they can pickup fibroids and endometriotic cysts even when they're as small as one centimeter is size. ( In fact, I'd bet that it's possible to find at least one "abnormality" in any women I can, no matter how fertile she is, if I look closely enough !) Now when the ultrasonographer sees these " lesions ", he has to report them. In fact, he highlights these as abnormalities in the report of the pelvic scan. The doctor picks up these abnormalities ; and explains to patients that these need to be corrected, before doing IVF. This makes logical sense, and because patients don't know any better, they sign up for the surgery.
However, the surgery doesn't help at all ! Fibroids are usually innocent bystanders and don't affect fertility at all, as long as they don't impinge on the endometrial cavity. Similarly, there's really no advantage to or treating endometriosis prior to IVF, because this "treatment" doesn't increase embryo implantation rates at all . In fact, this surgery can actually reduce IVF pregnancy rates, because every time endometriotic tissue is removed from your ovaries, normal ovarian tissues is also sacrificed at the same time. This reduces your ovarian reserve, and can end up in your growing few eggs and getting only a few embryos to transfer.
If your gynecologist thinks you need IVF, and suggests that you do endoscopic surgery prior to referring you to an IVF specialist, it's a good idea to first meet the IVF specialist and ask him if the surgery is really required, before giving consent for the surgery !
