【Laparoscopy】Application in the Diagnosis and Treatment of Infertility

Hysteroscopy has an irreplaceable effect in the diagnosis and treatment of infertility. Many women need to undergo laparoscopic surgery to deal with related problems before they can use assisted reproductive technology (ART) to obtain a successful pregnancy. In recent years, as the safety of hysteroscopic laparoscopic surgery and the rapid advancement of various surgical instruments have been solved, most patients who had to enter the abdomen for infertility correction surgery can now be completed under laparoscopic surgery; and many reasons Infertility caused by uterine cavity factors can be corrected by hysteroscopic surgery. This has brought the gospel to the majority of women with infertility.


Indications of hysteroscopy
·Hysterosalpingography prompts pelvic adhesions
·The hysterosalpingography shows the adhesion of the distal fallopian tube, but the shape of the fallopian tube is still normal
·Ultrasound prompts intrauterine lesions (submucosal sarcoma, endometrial polyps, etc.), and need to understand fallopian tube function
·Suspected fallopian tube obstruction and need hysteroscopic tubal intubation for fluid or dredging
·Suspected hydrosalpinx surgical treatment and need to understand the intrauterine environment
·Recurrent spontaneous abortion or infertility with suspected uterine malformations
·Laparoscopic monitoring of complex hysteroscopic surgery
 
Choice of operation time
Usually performed in the follicular phase (ie within 3-7 days after the net); the luteal phase tubal drainage may be caused by the floating intima covering the opening of the fallopian tube in the uterine cavity, resulting in a false positive result of high fallopian tube obstruction, and may even block the intima Fallopian tube, so avoid tubal drainage during this period. And premenstrual examination is conducive to the naked eye identification of endometriotic lesions in the pelvic and abdominal cavity.
 
Use in infertility
Modern hysteroscopy technology has been able to perform minimally invasive correction surgery for infertility at the same time as the diagnosis.
1. Pelvic adhesion decomposition
Separate and wrap the adhesion between the fallopian tube and the ovary and the adhesion behind the uterus, restore and reconstruct the normal anatomical relationship of the internal reproductive organs.
Hysteroscopic intubation of fallopian tube through fluid
3. Fallopian tube surgery: tubal stoma, fimbria formation, tubal anastomosis, etc.
4. Ovarian and pelvic lesion surgery: removal of uterine fibroids, removal of ovarian cysts, removal of endometriosis, etc.
5. Intrauterine surgery: resection of uterine polyps and submucosal fibroids, uterine adhesion decomposition, tubal obstruction intubation dredging, etc.
 
Precautions after operation
1) Ask the doctor about the operation and the next treatment after the operation.
2) After the operation of patients with endometriosis, the doctor will advise you whether or not to add medications, as well as the complications of various medications, choice of medications, and medication plans. Some patients require fertility treatment after surgery. Endometriosis is a disease that tends to recur, and there is a possibility of recurrence for a long or short time after surgery. Please contact a physician in the department of reproductive medicine for active treatment after the operation.
3) Patients with a history of abdominal pain or low back pain may get better after laparoscopic surgery. However, due to its complicated etiology, the symptoms of abdominal pain or low back pain may not be completely resolved after surgery.
4) If the pathology report after the operation suggests 'benign', please come to our hospital for follow-up visits one month after the operation and make the next treatment plan.
5) For patients with chronic pelvic inflammatory disease, if they have a clear fallopian tube, they can try to get pregnant, but once they become pregnant, pay attention to distinguishing the situation of ectopic pregnancy; if you are not pregnant for one year after the operation, you should consider that the effect of the operation no longer exists.