Laparoscopy: good or bad for IVF patients?

07 Nov Laparoscopy: good or bad for IVF patients?

A laparoscopy can treat women with specific infertility problems. It could be a key procedure for prospective IVF patients – and others trying to identify a gynaecological cause for their infertility. But IVF patients have had many tests already. Will an invasive laparoscopy really find anything new?

In 70 per cent of cases, nothing is found in a laparoscopy. And when it is, an operation doesn’t always achieve much. Tubal surgery may not be necessary for IVF patients, since IVF bypasses the fallopian tubes. Hydrosalpinges may need dealing with, though, since they can leak into the uterine cavity.

Laparoscopy surgery can also increase the risk of an ectopic pregnancy. And removing endometriosis doesn’t permanently stop it from coming back. That’s why most fertility clinics stop at an HSG. If that looks good, most say a laparoscopy is overkill.

Contrast that view on laparoscopy with recent research from Stamford University. This found that a laparoscopy can be good for IVF patients. A majority of unsuccessful IVF patients, who then had a laparoscopy to treat endometriosis, successfully conceived after surgery. Since many women with infertility have endometriosis, this is significant. The study concluded that women often rush into IVF, expecting instant results, without checking for endometriosis at all.

This is backed up by a 2019 study of laparoscopic surgery and IVF. It found that a laparoscopy was beneficial to IVF patients with unexplained infertility and past failed cycles. For this group, detecting peritoneal endometriosis, adhesions and tubal issues was relevant to past IVF failures. A study one year earlier also said laparoscopies could boost IVF outcomes.

For most IVF couples, though, a laparoscopy is a last resort. They’ve had their hormone profile tests, semen analysis and scans. Some will have had the HSG, a less full-on assessment of their reproductive organs.

Keyhole surgery, which is what a laparoscopy is, remains something IVF patients steer clear of. It’s also expensive, if done privately. And yet it can isolate a previously undiagnosed problem. The laparoscopy might just have an image problem.

In a laparoscopy, a small incision is made in your abdomen. A thin tube, with light and camera attached, is guided into your pelvic area. Secondary incisions may also be made, allowing small surgical tools and gas to be pumped in. This ensures a better view. The objective? To seek out cysts, fibroids, endometriosis, pelvic inflammatory disease and other physical anomalies.

A laparoscopy can be diagnostic or operative, or both. Some tubal repairs may be unnecessary before IVF treatment. But if you’ve had two or more failed IVF cycles, a laparoscopy might be recommended. Most of the time, however, it won’t be.