Exploring Laparoscopy in Fertility Diagnostics

By Constance McGraw, MPH

What is laparoscopy?

Laparoscopy is a minimally invasive procedure using a small camera (laparoscope) and several small incisions to examine the abdomen and reproductive organs, avoiding the need for a large incision. Laparoscopy is considered a safe procedure and is used to help diagnose medical conditions and take biopsies of tissues. Gynecologists and obstetricians routinely use laparoscopy to diagnose (diagnostic or exploratory laparoscopy) and address (operative laparoscopy) issues contributing to infertility.

Laparoscopy for infertility

Laparoscopy for infertility becomes a viable option when other fertility tests fail to yield a conclusive diagnosis. Additionally, it is recommended for cases of unexplained infertility or when women experience pelvic or abdominal pain or have a pelvic mass. Notably, any identified issues can often be addressed during the same laparoscopy procedure. Laparoscopy can also be used to diagnose and treat the following medical conditions:

• Endometriosis
• Tubal sterilization 
• Pelvic floor disorders
• Ovarian cysts
• Ectopic pregnancies
• Fibroids
• Cancer 

Laparoscopy procedure 

Laparoscopy is routinely an outpatient procedure with the following steps:

1. Anesthesia is typically administered for comfort during the procedure.
2. A small incision near the belly button or lower abdomen is made to introduce the laparoscope, a tool equipped with a camera for visualizing the internal organs.
3. The abdomen is filled with a harmless gas to gain a better viewing of your abdomen and pelvic organs.
4. Images of the pelvic organs are transmitted to a screen via the camera. Occasionally, additional incisions are made for specialized tools.
5. An instrument called a uterine manipulator may be inserted through the vagina and cervix into the uterus to move the organs into view.
6. The surgeon employs other instruments through small incisions, typically no longer than half an inch if treatment is needed.

Laparoscopy for endometriosis

Laparoscopy is the preferred method to officially diagnose and treat endometriosis, as it offers decreased recovery time and costs compared to other surgical procedures. A gynecologist may have high clinical suspicion of endometriosis based on symptoms during a pelvic exam, but an official diagnosis cannot be made until laparoscopy. Laparoscopic surgery attempts to treat the pain, infertility, and other symptoms associated with endometriosis through the removal of endometriotic lesions and adhesion repair of damaged organs and other affected areas. Laparoscopy can remove tissue associated with endometriosis by cautery (electrical energy), laser, or excision (surgical removal). Laparoscopic surgery aims to lessen pelvic pain associated with endometriosis and to improve fertility. While one RCT reported that laparoscopy excision was more effective than placebo at reducing pain and improving quality of life, 20% of women did not report any improvement in surgery. Additionally, a 2020 Cochrane systematic review revealed that it is still uncertain whether laparoscopy surgery relieves pain, with moderate to low evidence and more research needed on effectiveness and safety.

Laparoscopy and IVF

Laparoscopy has been suggested to improve pregnancy rates when performed prior to IVF. If repeated IVF attempts have been unsuccessful, a diagnostic laparoscopy might be recommended by your healthcare provider to assess abdominal or pelvic organ issues before another IVF cycle. According to a Cochrane review, surgical laparoscopy could moderately improve pregnancy rates, supported by moderate to low evidence. While systematic evidence for routine use of laparoscopy before IVF is limited, it may be considered on a case-specific basis.

Recovery from laparoscopy

Following a diagnostic or exploratory laparoscopy, expect a brief downtime of a few days with fatigue and mild discomfort. You might notice soreness near the incision site and experience bloating or lower back pain due to residual gas in your abdomen from the procedure. However, the recovery period for surgical laparoscopy varies based on its complexity. Your healthcare provider will advise you on when to resume your regular activities.

Risks of laparoscopy 

Fortunately, the overall rate of severe complications linked specifically to laparoscopic procedures remains low. However, it is important to be aware of potential issues like vascular injury or bowel perforation, which are the primary contributors to morbidities and rare instances of mortality in laparoscopic surgeries. The occurrence of complications specific to laparoscopy is uncommon. For instance, in gynecologic laparoscopies, the occurrence of any complication ranges from 0.2% to 18%. Major complications are even rarer, with rates ranging between 0.6% to 14.6%. 

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References:

1. The American College of Obstetricians and Gynecologists (ACOG) 2021. Laparoscopy. Retrieved November 2023 from: https://www.acog.org/womens-health/faqs/laparoscopy
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