Nowadays, laparoscopy is not done routinely in the infertility workup of female patients. It should be done when the previous examinations have shown:
- A history of sexually transmitted disease with the risk of having intra-abdominal adhesions and infected tubes
- An abnormal ultrasonographic finding that is suspicious and needs further analysis e.g. for endometriosis (tissue of the uterus-lining has implanted outside the uterus and forms cysts or scarring) or hydrosalpinx (tube filled with fluid)
- Unexplainable pain in the lower abdomen
Laparoscopy should always be combined with a hysteroscopy to assess the uterine cavity.
Laparoscopy is also known as “key-hole” surgery and it is performed under general anesthesia. Through a small cut in the region of the belly button, a laparoscope will be inserted into the abdominal cavity and pelvis area and Carbon Dioxide (CO2) gas is introduced. If further laparoscopic surgery is required, additional small incisions may be made and a variety of instruments can be inserted to perform diagnostic and corrective surgery.
After the operation, most experience symptoms that could last for several days. The symptoms are tiredness, mild nausea and pain around incision sites, abdominal pain or cramps, tenderness, shoulder pain, and abdominal bloating as well as a small amount of vaginal discharge or bleeding.
Laparoscopy should be avoided if not necessary as there might be complications, even if the risks are low. The risk of serious complications is less than 1% especially if the laparoscopy is performed by a highly trained fertility surgeon.
Complications associated with laparoscopy include the possibility of damage to other organs in the abdominal cavity and/or the pelvis such as bladder, uterus, ureter, bowel, and blood vessels. Unnecessary interventions on the uterus or the ovaries should be avoided as they could even decrease the chance of pregnancy or increase the risks during pregnancy.