Walid Saleh, MD – Laparoscopy: Avoid It If You Can!

07 Apr
Dr. Walid Saleh

Dr. Walid Saleh of Sher Fertility Dallas Offers Insights on Laparoscopy

Many doctors perform a laparoscopy for infertile women or “want to check that everything is ok prior to IVF”. Unfortunately, while it sounds effective, this is another useless procedure. I advise you to avoid it, no matter what your insurance covers. The reasons are simple: most of the time nothing is found, and even when there is something wrong (by laparoscopy or HSG), surgical repair is not effective.

The fact is that even in young women with normal ovarian reserve, the “yield” of laparoscopy in women with unexplained infertility is very low. In seventy percent of women (70%), the laparoscopy is completely negative. In the 30% with pathology, half have tubal adhesions (15%) and half are found to have endometriosis (15%).

In those with tubal disease, first time surgical correction is notoriously frustrating with a cumulative pregnancy rate of 30-40% over 24 months.  For those undergoing a second surgery, pregnancy rates are in the range of 5%.  In contrast, IVF is twice as effective over a shorter time without the surgical risks. Of those who ultimately conceive after tubal surgery, the risk of ectopic pregnancy is close to 30%, adding more risk, expenses and frustration to your infertility journey.

When endometriosis is discovered, surgical removal of visible lesions rarely improve the prognosis because endometriosis is a microscopic disease toxic to sperm, eggs and embryos. While the pelvic cavity looks great in the operating room, those lesions re-grow and scar tissue re-forms quickly after surgery. In other words, when the HSG is normal, if all the roads lead to IVF after 3-6 courses of clomiphene/IUI, why do the laparoscopy in the first place?

The only indication for surgery would be relief of painful intercourse or menstruation, not infertility treatment. If the ovaries have large endometrial cysts (“chocolate cysts”), then surgical correction may be justified but ultrasound guided cyst aspiration, a safer and non-invasive approach should also be considered because ovarian cyst removal (cystectomy) can seriously affect your ovarian reserve and affect your overall chances of pregnancy.

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126 Comments

  • Natalia says:

    Hi doc,
    I feel so deflated and anxious now more than ever after reAding this article.
    I have PCOS, and hashimotos/hypo, I also have been struggling to conceive.. I have underwent tests like AMH (pointless because it confirms my PCOS) and hycosy which showed eventually afer dye pushed through that both tubes patent.. Fell preg last year it was a tubal ectopic and I underwent MTX shot and saved the right tube.
    However performed another hycosy and found left was blocked and right eventually patent?!

    Was advised to perform a lap/d&c/hyster by 2 diff specialist to incr chance of fertility and clean me out and investigate and through that removed a uterine polyp (found under the lap), confirmed left tube blockage and right patent.. Yet no reason why the left is blocked as no adhesions scar tissue etc or infection? So why is it blocked when before I TTC they both were open?? I’m so confused and now after reading your article scared that I will get scar tissue after the lap and become worse as I’m already higher risk of another ectopic?
    Dr says try naturally then go on clomid after 3 months natural.. However I’ve read cod is also linked to ectopic …
    I’m so scared and confused should I just go straight to IVF? Is that my only safe option

    • Walid Saleh, MD says:

      Laparoscopy the least effective option. It only confirms what we already know and rarely fixes the blockage. Because you had an ectopic, we know there is tubal factor infertility. Honestly, I would advise IVF rather than repeated surgeries. Hope that helps.