Laparoscopy: Avoid It If You Can!

07 Apr
Dr. Walid Saleh

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

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.

Learn more Dr. Walid Saleh and Sher Fertility Dallas, TX.

92 Comments

  • Jane says:

    Hi Dr,
    We have been ttc for 4 years almost. I am 33, my husband is 47 with male factor issues (low motility and morphology), we did 2IUI-s (no success), 3 fresh ivf (one blighted ovum and one chemical) and 3 FET (no success). My specialist said that I should go for a laparoscopy, although I had a HSG and office hysteroscopy and everything is ok. I have no symptoms of endometriosis neither. I am hesitating and between my specialist and my gynaecologist opinion (who doesn’t recommend lapar). I really would like to know your opinion. Should I go for laparoscopy or go for further ivf? Thank you for your opinion!

    • Geoffrey Sher says:

      Frankly, unless your US reveals an endometrioma (chocolate cyst of the ovary) or some other pathology that needs to be addressed, I do not think a laparosopy is necessarily indicated. I would however undergo immune testing to exclude a natural killer cell cytokinopathy which is present in 1/3 of cases of endometriosis regardless of severity and if present could prevent success. Thereupon, I would go directly to IVF.

      Please go to the home page of this blog, http://www.IVFauthority.com . When you get t there, find the search bar and type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

      5. “Thyroid Autoimmune Disease and IVF”

      6. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      7. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      8.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      9. “IVF success: Factors that influence outcome”

      10. “Use of the Birth Control Pill in IVF”

      11. “Endometriosis”

      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.

      I Will be hosting a 2 hour a webinar on our website (www.haveababy.com ) on the evening of January 29th,. The topic will be “Management of Immunologic Implantation Dysfunction as a Cause of IVF Failure and Recurrent Pregnancy Loss”. I urge you to enroll on this website or to contact Tom Anderson at toma@sherinstitute.com ASAP to enroll as it is filling up rapidly.

Leave a Reply

Your email address will not be published.