In addition to the full spectrum of infertility services offered at California IVF Fertility Center, there are many surgical procedures offered to patients who may or may not be currently seeking infertility treatment. Dr. Zeringue has particular expertise with laparoscopy, endometriosis, uterine fibroids, and tubal re-anastomosis. Below you will find an introduction to the individual procedures offered. For a discussion of your individual options please schedule an appointment by calling 530-771-0177.
Many infertility surgeries not required for general health and well being but may be very beneficial in helping women achieve a successful pregnancy. The indications of the procedure and alternative treatments will be discussed before any surgery is planned. It is imperative you make an informed decision about surgery. You should never feel pressured into having surgery and you should not agree to surgery without understanding everything. If you decide to have a surgical procedure to help with your fertility care, there will be several steps involved.
After a thou rough discussion of your options and the surgery to be performed you will need to sign an informed consent document. This document is simply a statement saying you understand the procedure, risks, and alternatives. Often, these documents list most of the complications that can occur from surgery. This is not to frighten you but is considered necessary information. You should feel comfortable asking about these complications. The consent document does not obligate you to surgery and you may change your mind at any time before the surgery.
Preop – Once your surgery has been scheduled and you and your physician have discussed the operation to be performed, you will be scheduled for a preoperative appointment. These appointments frequently involve preadmission paperwork and instructions. You may have blood tests drawn before or during this appointment. A pregnancy test and blood count are the most common tests. Most of the time these preoperative appointments will occur at the surgery center or hospital. Additional instructions about this appointment will be provided when your surgery is scheduled.
Be certain not to eat or drink anything on the night before your surgery. This is called “NPO”. You will be given a time to start fasting. This is very important to reduce the risk of complications. If you do not follow these instructions you run the risk of having your surgery canceled for your own safety.
Post Op – Following your surgery your recovery time will vary depending on the procedure performed. Most laparoscopy cases are done as same day surgeries. Myomectomies and tubal reversals are most often done as extended outpatient procedures. This simply means the patient remains overnight but is not admitted as an inpatient (This allows for a significant cost savings). Following your procedure you will be given written discharge and post operative instructions. Activities and diet are limited by your level of comfort. Start slowly and gradually progress your level of activity as tolerated. Laparoscopy, hysteroscopy and D&C procedures have quicker recovery times than the more major procedures. You should be able to resume driving within 24 hours provided you are not taking medications that impair your abilities to drive. The major procedures involving a laparotomy (large incision in the abdomen) will require a longer time of recovery. After a major surgery you should avoid driving for up to 4 weeks. Follow up visits are usually scheduled at the time your surgery is scheduled. They will range from 1-4 weeks after your surgery depending on the procedure and availability of appointments.
There are many different types of surgeries that are possible when one considers the multiple combinations of procedures possible. Among these are the following:
Hysteroscopy Laparoscopy Myomectomy Tubal reanastomosis Neosalpingostomy Chromopertubation Hysterectomy
Diagnostic & Operative Hysteroscopy involves the use of a thin scope to look into the cavity of the uterus. The scope can be used to guide operative instruments.
Diagnostic & Operative Laparoscopy involves placing a scope into the abdominal cavity through a small incision at the navel. One and sometimes more smaller incisions may be made in the abdomen to introduce instruments used to explore the abdominal cavity and perform the necessary surgery. When the doctor looks inside the abdomen to try to find out why a woman can’t become pregnant, the procedure is called a diagnostic laparoscopy. This procedure may be able to diagnose blocked fallopian tubes, endometriosis, uterine abnormalities, and other problems that may prevent pregnancy. When surgery is done through the laparoscope, the procedure is called an operative laparoscopy. Often times a chromopertubation is performed at the time of laparoscopy to determine if the tubes are open. [More Information]
A myomectomy is a procedure involving the removal of a fibroid or fibroids, also known as myomas or leiomyomas. Fibroids that impact the cavity of the uterus can cause infertility. A myomectomy is a surgery that can improve fertility and increase the chances of having a baby. This procedure can be performed by laparoscopy but more commonly it is performed by a larger incision in the lower abdomen. This allows more precise control of the surgery and a lower chance of damaging the uterus. If you are considering a myomectomy, you will want to select a surgeon with skill and experience in preserving fertility. [More Information]
Tubal reanastomosis is a microsurgical procedure where the ends of a previously interrupted tube (tubal ligation) are put back together. This allows for attempts at pregnancy following a tubal ligation without having to undergo IVF. There are many types of tubal ligation procedures and most of them can be reversed. For many women, a tubal reversal can give them a high chance of pregnancy. [More Information]
This is a procedure where blocked or dilated tubes are opened and the ends of the tubes are surgically recreated. This allows attempts at achieving pregnancy without IVF. This procedure is performed less commonly now that IVF has become a very successful procedure. Previous damage to the fallopian tubes may increase the risk of an ectopic pregnancy (a pregnancy outside the uterus – sometimes called a tubal pregnancy). If the fallopian tubes are filled with fluid they are referred to as hydrosalpinges. Hydrosalpinges should be opened using a neosalpingostomy procedure or they should be removed, neosalpingectomy. In a few instances, drainage of the tubes may avoid the need for surgery and allow a woman to proceed with IVF. These options must be discussed in detail before any type of surgery or treatments are performed.
This procedure is often done in combination with the other procedures. This involves injecting colored liquid through the fallopian tubes and watching the ends of the tubes for the dye. Spillage of dye indicated open (patent) tubes. This is done sometimes when an HSG procedure shows a blocked fallopian tube. If the blue dye can not be seen coming out of the fallopian tube, there is most often a blockage of the tube.
This is the removal of the uterus and cervix. There are many reasons for this procedure to be performed. Vaginal hysterectomies involve the removal of the uterus through the vagina while abdominal hysterectomies require a laparotomy (incision into the abdomen). Vaginal hysterectomy is usually associated with fewer complications and faster recovery. Oophorectomy This is the removal of the ovaries. Removal of the ovaries does not have anything to do with the terms complete or partial hysterectomy (complete and subtotal (partial) depend on the removal of the cervix).