Laparoscopy: Avoid It If You Can!

07 Apr
Woman with IV

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.

66 Comments

  • sangeeta says:

    i am 28 years old and our marriage is 3 years old. last sept, my periods got delayed by a week. upon consulting a gynocologist, i came to know that i’m suffering from PCOS and have been taking treatment for the same.
    meanwhile the doctor performed both HSG and DnC whose results were normal. during this time IUI was also performed four times all of whom failed. now, the doctor has suggested to undergo IUI one more time or get laproscopy done.
    during last IUI(mar-14) the doctor had informed that PCOS is almost nil but even that IUI failed. we both are very depressed and not sure how to proceed further.
    need your help. thanks in advance.

    • Geoffrey Sher says:

      I wish I could help you, but to do so I would need much more information than you have (or perhaps can) provided. Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

  • salwa sagar says:

    hi doctor..its 14yrs since igot married having no kids .now 32 yrs while my husband is 44.iwent long journey of treatments when icame across finding that igot hydro. my gyno suggested me alaporscopy that I did last month and the results are normal …they repaired my tubes and they gave me hope that everything is ok now..that iwil concieve naturally now…with my hope that nxt month iwill get pregnant but again NEGATIVE soo disappointed plz help . am frastuated!

    • Geoffrey Sher says:

      If you had a hydrosalpinx , in my opinion you need IVF. I probably would have advocated removing them because they are functionless and their presence can impede successful IVF.

      Geoff Sher

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