Restorative Reproductive Surgery

Restorative Reproductive Surgery

Restorative Reproductive Surgery is surgery done to restore your reproductive function.

Common Questions about Restorative Reproductive Surgery

How is that different from removing a cyst or adhesions or scar tissue during surgery?

Those procedures may restore reproductive anatomy by putting your organs back where they are supposed to be, and they can help with restoring reproductive function. However, that doesn't mean that all function is completely restored! For example, you might have a blocked fallopian tube that isn’t detected and hence left untreated during conventional laparoscopy.

This is not to fault the surgeon; if the goal of the procedure was to remove adhesions, and that was done, the surgery was successful. But the main goal of the restorative reproductive surgery we perform is to surgically restore reproductive function. Before we attempt to restore function, we need to find out what reproductive function is not functioning. 

What exactly about reproductive function are you trying to restore?

The majority of the time - it is restoration of fertility. However there are other reproductive functions such as irregular bleeding due to polycystic ovarian syndrome (PCOS) that can be corrected with surgery. Excision of endometriosis is another form of restorative reproductive surgery. By excising endometriosis we can improve fertility as well as alleviate pelvic pain to restore sexual and reproductive function. But restorative reproductive surgery for the most part aims to treat infertility by enhancing reproductive potential. 

Is surgery always needed to restore reproductive function?

No, in fact, many times, non-surgical treatments will be successful in enhancing reproductive function and hence fertility. For example, ovulation dysfunction as a result of PCOS is usually successfully treated with medicine, resulting in the restoration of function and fertility. But it is equally important to recognize that there are some instances where surgery is necessary to restore fertility. If the problem is surgical then it doesn't matter how much medicine is used, you will not be able to spontaneously conceive. 

When would you recommend restorative reproductive surgery?

There are a couple of rules we follow when evaluating and treating infertility.

Rule 1: Before Fertility Treatment

The first is that surgical evaluation should always be done as part of an infertility workup. Also, a woman should not be diagnosed with unexplained infertility without first having that surgical evaluation. We strongly believe that pharmaceutical treatment, especially with high potency ovarian stimulating agents (known as the ''injectables''), should not be started until restorative reproductive surgery has been done. This is because high potency ovarian stimulating agents may actually make certain diseases (e.g. endometriosis) progress at a faster rate and cause worsening infertility and pain.

Rule 2: Women with Unsuccessful Fertility Treatment

The second rule applies to women currently undergoing fertility treatments but have not had a surgical evaluation. After six to twelve months of unsuccessful fertility treatments, the patient should have a surgical evaluation to see if there is a cause that can be corrected surgically - before resuming other treatment. In some cases, patients may spontaneously conceive even without further fertility treatments following restorative reproductive surgery. 

Does restorative reproductive surgery guarantee a pregnancy?

No. Keep in mind that there are often many factors contributing to infertility. When evaluating and treating infertility, we should look at it from all possible angles, including both medically and surgically. The CRRS strongly recommends patients work with a medical provider who will primarily be taking care of their infertility. The surgery we perform integrates into the patient's infertility management. We believe that surgical evaluation and treatment for infertility are often overlooked and this is a huge disservice for patients. We have frequently seen patients being treated for three or even five years medically before having surgery for infertility. This is unfortunate because during these years the woman's egg reserve continue to decline while the disease process continues to progress. 

I have not one but multiple surgeries in the midst of my fertility treatments and am still unable to conceive. What's your take on that?

I think that it is important to know what was being done at the time of surgery. Very often, surgeries are done for a specific reason, e.g. removing a cyst or removing a fibroid or treating endometrioisis. Surgeries are rarely done as part of an exploratory surgery for a fertility workup where comprehensive evaluation and treatment are done. When endometriosis is found, excision of endometriosis should be done meticulously and completely. To give you some idea, a typical restorative reproductive surgery for fertility typically lasts for 3-4 hours and begins at the vaginal canal and ends in the abdominal cavity.

My fertility specialist stated that after a workup followed by a period of medical treatments with timed intercourse, my next step is IUI and following that IVF. They said that this is our best chance to conceive. Is that true?

This is where the philosophy of the restorative approach differs greatly from the artificial reproductive technology (ART, e.g. IUI, IVF) approach.

With the restorative approach, the goal is to achieve pregnancy naturally by restoring function. The restorative approach looks at infertility as a symptom. This means we look for the underlying disease that needs to be treated in order for the function (fertility) to be restored.

The effect of ART is to bypass function. Typically when function is bypassed, little emphasis is placed in looking for the root of the problem and treating it properly. Consequently, ART can sometimes result in pregnancy at a faster rate than the restorative approach.

However, ART is not ideal for two reasons:

The first is that the root of the problem is not discovered, and not treated.

The second is that because function is not restored, ART is needed every single time a function needs to be bypassed to achieve a pregnancy. This means IUI and IVF is a cycle-based treatment.

In contrast, when function is restored surgically, then function is good for all subsequent cycles. Furthermore, the underlying disease is treated as well resulting in a healthier you - a big benefit when considering pregnancy and motherhood. 

Picture an example of broken plumbing: if your shower is not working, you have two options:

  • Option 1: painstakingly look at the piping, perhaps tracing all the way to the source to see what is going on and fix it. You may need to open walls, or replace tiles, and it might take an investment of time.
  • Option 2: simply fill your sink with water and wash. This is much quicker, but not ideal because every time you need to clean yourself, you need to do this.

On the other hand if you choose the first option, even though there is more work and time involved (initially), once the plumbing is restored, it's good for all subsequent showers.