Keterangan
Laparoscopy for infertility is a minimally invasive surgical procedure that uses a laparoscope (a fiber-optic tube with light and video camera) inserted through two or more minor incisions, often in the belly button. The surgeon can then visually examine the pelvic reproductive organs and the pelvic cavity. In the past, laparoscopy was a standard diagnostic tool for women with unexplained infertility. The increased use of assisted reproductive technologies, such as in vitro fertilization (IVF), has led some doctors to recommend IVF right away, before laparoscopy. However, a doctor may still recommend laparoscopy if they believe that it can help.
Ringkasan
- Laparoscopy plays a key role in infertility diagnosis and treatment, offering a panoramic and magnified view of pelvic and abdominal organs, and enabling extensive surgeries. Indications for laparoscopic surgery include age over 25 with three years of infertility, unexplained infertility, and pelvic factors like tubal blocks, fibroids, endometriosis, PCOS, and Mullerian anomalies. Common laparoscopic surgeries include diagnostic laparoscopy, ovarian drilling, adnexa lysis, myomectomy, tubal surgeries, and endometriosis treatment.
- Ovarian drilling, or LOD, involves multiple ovarian punctures to address anovulation in PCOS patients, especially when ovulation induction fails. While the exact mechanism is not fully understood, it is believed to decrease androgens, LH levels, and increase sensitivity to FSH. Success predictors include young age, short infertility duration, lean PCOS, high AMH, and absence of other fertility factors. The procedure involves electrocautery with specific parameters to avoid damaging the ovarian reserve.
- Laparoscopic surgery addresses tubal factors, accounting for 25-35% of female infertility, often due to salpingitis. Tubal patency is best assessed through diagnostic laparoscopy, which is more reliable than HSG. Distal tubal diseases like hydroalpinx and fimbrial phimosis can be repaired. Salpingectomy for bilateral hydrosalpinx yields higher IVF pregnancy rates. Tubal anastomosis is an option for sterilization reversal and mild tubal blocks, but contraindicated in severe tubal disease or advanced endometriosis.
- Endometriosis, occurring in 6-20% of reproductive-age women, presents with varying appearances, including powder burn lesions and endometriomas. Ovarian endometriomas are pseudocysts of ectopic endometrial tissue, diagnosed by TVS. Treatment involves lesion destruction via excision, coagulation, or laser. Fibroids are common benign tumors, and myomectomy is performed for submucosal and intramural fibroids close to the endometrium. Laparoscopic myomectomy offers advantages like reduced pain and shorter hospital stays.
- Laparoscopic surgery can address Mullerian anomalies, including unicornuate uterus (surgical resection of non-communicating horns), didelphys uterus (metroplasty), and septate uterus (hysteroscopic resection). Surgical options depend on the type and severity of the anomaly. In summary, laparoscopy is a crucial tool for fertility enhancement, requiring prior evaluation and skillful execution.
Contoh Sertifikat
Tentang Pembicara
Dr Chethana
Obstetrician-Gynecologist Director of Mathruchaya Multispeciality and Fertility Centre.
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