Fertility surgery : overview

Do we always need a diagnostic laparoscopy ?

A fertility exploration investigates all infertility factors. Without a laparoscopy it is imposible to know whether there are adhesions (eg after infektion or surgery) or whether there is minimal endometriosis

All decisions are based upon the knowledge that
after 1 year of infertility still 80% will get pregnant spontaneously over the following years
after 2 years of infertility the cumulative pregnacy rate drops to 50%
after 5 years : less than 20% will get pregnatn spontaneously

Adiagnostic laparoscopy is planned after 1 year in Belgium ; after 3-4 year in the UK

Is fertility surgery done during the diagnostic laparoscopy ?

Ideally this should be done, but practically there are a series of problems such as

the absence of a CO2 laser : the quality of endometriosisq surgery is less, and the intervention takes a longer time with more adhesions .

a ’slow or less experienced surgeon ‘ has more adhesions because surgery takes longer and because of more surgical trauma

Surgery beyond the level mastered : causes damage (destruction of the ovary) and incomplete excision of endometriosis or unnecessary bowel resections and thus IVF.

Problems and possible solutions

Fertility Centers have become IVF centers with most gynaecologists having only a limited surgical experience (basal level)

Already during a plenary lecture at ASRM, Prof Koninckx addressed this when he got the award of Distinguished Surgeon. He suggested that a quality control in surgery should become mandatory (eg though videoregistration ). He concluded with the one liner ‘ this will safe a lot of money since it will reduce the number of IVF cycles and since a surgery baby costs 5 times less than an IVF baby.