Reproductive Surgery

SIRM Physicians are able to perform a full range of reproductive surgery including:

Laparoscopy
This ambulatory procedure (outpatient surgery) is usually performed under general anesthesia. It involves making an incision in the woman’s belly button through which a narrow telescope-like instrument is passed into the pelvic-abdominal cavity in order to permit visualization of pelvic structures. Fine surgical instruments can be passed through a side channel in the laparoscope or via separate puncture sites in the lower abdomen, for the performance of a large variety of therapeutic procedures (see below). Diagnostic laparoscopy has become an important part of evaluating female infertility in cases where organic pelvic disease is suspected.

Hysteroscopy
This is a procedure where a thin telescope-like instrument is passed via the vagina through the woman’s cervix into the uterine cavity in order to evaluate its inner structure for the presence of disease or congenital malformations. The procedure can safely be performed under local anesthetic as an outpatient but is often combined with diagnostic laparoscopy. As with the latter, fine surgical instruments can be passed via the hysteroscope for the performance of corrective surgery.

Sclerotherapy for Ovarian Cysts (Endometriomas)
Sclerotherapy is a safe and effective alternative to surgery for definitive treatment of recurrent ovarian endometriomas in a select group of patients planning to undergo IVF. Sclerotherapy for ovarian endometriomas involves: needle aspiration of the liquid content of the endometriotic cyst, followed by the injection of 4-5% tetracycline into the cyst cavity. Treatment results in disappearance of the lesion within 6-8 weeks in more than 75% of cases so treated. Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia.  It has the advantage of being an ambulatory office-based procedure, at low cost, with a low incidence of significant post-procedural pain or complications and the avoidance of the need for laparoscopy or laparotomy.

Testicular Sperm Extraction (TESE)
TESE is a procedure involving the introduction of a thin needle directly into the testicle(s), under local anesthesia, without making a skin incision. Hair-thin specimens of testicular tissue are removed (usually under local anesthesia) in the space of 15 to 30 minutes. Sperm are extracted from the tissue and each egg is injected with a single sperm using the ICSI technique. It is most commonly done in cases of spermatic duct (vas definers) occlusion or absence but can also be performed in cases of ejaculatory dysfunction, such as might occur following spinal cord injuries, after prostatectomy, or in cases of intractable male impotency. TESE is simple, relatively low-cost, safe, and virtually pain-free. Most men can literally take off a few hours for the procedure and return to normal activity straight away.