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.

74 Comments

  • Casey says:

    My doctor did an HSG on me and then said I needed to get laproscopy done then go with IVF due to tubial adhesions. I want to avoid the laproscopy. Is that possible to go straight to IVF?

    • Geoffrey Sher says:

      In my opinion, in most cases, provided the patient does not have complications requiring attention surgically and one or both Fallopian tubes do not contain fluid collection (hydrosalpinx) surgery(laparoscopy) might well be avoided.

      Geoff Sher

  • Jessica says:

    My husband & I have been ttc for 3 years. For the past 1 1/2 years we have tried clomid & letrozole, with and without iui’s. No success, though we did have success with clomid alone two years ago. Over the past 3 years I have had multiple ultrasounds. At the last cd 13 ultrasound, the doctor noted a growth on the ovary and wasn’t sure if it was a cyst or possibly endometriosis. I was asked to come back for a cd 3 ultrasound if the cycle was unsuccessful, which it was. At the cd 3 ultrasound (17 days later), the “growth” wasn’t much bigger, measuring at 20mm vs. 18 or 19 earlier. The doctor gave the ok for letrozole this cycle, but wanted another cd 3 ultrasound, again if unsuccessful and to possibly discuss a lap. We have already decided that if this cycle and the next are not, that we will move onto ivf. I am older, just tuning 38, but my amh/fsh/etc… are all acceptable numbers. Could we do ivf and still have a same chance at success if nothing much changes with the growth or would a lap be something to pursue beforehand?

    • Geoffrey Sher says:

      I suggest the ovarian “growth” be removed before moving to IVF. In my opinion, if it turns out to be endometriosis, you should also have an immunologic assessment before proceeding with IVF>

      Please go to the home page of IVFauthority.com. When you get there look for a “search bar” in the upper right hand column. Then 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. “Endometriosis”

      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

      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.
      .

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