What's at the first stop on the road to motherhood?

Tayfun Kutlu, MD. an obstetrician and gynecologist at Anadolu Medical Center and the Director of IVF Center, says “Problems in the uterus, Fallopian tubes and ovaries before IVF treatments are three main topics that bring up surgical treatment options”.

Ebru Ozturk Oksuz,MD., an obstetrician and gynecologist and IVF specialist at Anadolu Medical Center, says “After some surgeries, it is recommended that couples use the chance of natural pregnancy for one year, and if pregnancy does not occur at the end of this period, IVF treatment should be started”.

A healthy pregnancy undoubtedly depends on the harmony between the uterus and the embryo. For this reason, both the quality of the embryo and the health of the uterus are two important factors in this process. For couples who could not have a baby, if there are problems in the uterus, fallopian tubes or ovaries, these problems should be eliminated first and then IVF treatment should be started. When a couple who could not have a baby and applied for IVF in the past years, procedures such as diagnostic laparoscopy or diagnostic hysteroscopy were performed first, but today, based on recent information, it has been seen that these diagnostic examinations do not have a role in increasing the success of the treatment. Therefore, it is not correct to offer direct diagnostic laparoscopy or diagnostic hysteroscopy to a couple who cannot have children. So, which surgeries are recommended before IVF treatments, in which situations, when and for whom? Assoc. Prof. Tayfun Kutlu, MD. an obstetrician and gynecologist at Anadolu Medical Center and the Director of IVF Center and Ebru Ozturk Oksuz, MD. an obstetrician and gynecologist and IVF specialist of Anadolu Medical Center explain today's treatment methods for couples who are considering having a baby and address the commonly-asked questions.

WHAT SURGERY MAY BE NEEDED BEFORE IVF TREATMENT?

A detailed gynecological and ultrasound examination are performed for every woman who wants to have a child. Thus, problems in the uterus or ovaries can be detected. The hysterosalpingogram (HSG) test is a very valuable diagnostic method that allows us to understand the anatomical condition of the intrauterine cavity and Fallopian tubes.

However, although the HSG is among the basic examinations, its sensitivity is around 60 percent. This means that 40 percent may yield insufficient or misleading results. If there are problems in the uterus, ovaries or fallopian tubes, surgical options may be considered before IVF treatments to resolve these problems and increase the chance of conception. At this point, surgical hysteroscopy, laparoscopy or open surgery methods are used. In short, problems in the uterus, tubes and ovaries before IVF treatments are the three main topics that bring up surgical options.

INTRAUTERINE PROBLEMS ARE SOLVED THROUGH HYSTEROSCOPY

Hysteroscopy surgery, which is used in the treatment of intrauterine problems, is a method performed under general anesthesia by entering the uterine cavity through the uterine canal with an optical camera. When an anatomical problem, a polyp or a myoma protruding into the intrauterine cavity is seen, which changes the shape of the uterine cavity (such as a veil, deformity), disrupts its arrangement, adversely affects the implantation of the embryo, a previous infection or a surgical procedure (such as abortion), adhered areas inside the uterus occur, they can be corrected by hysteroscopy. Thus, it is possible to increase the chances of pregnancy. The method cannot be used in people with double uterus (that is, two completely separate half uterus). However, if there is a veil that narrows the intrauterine cavity, and if the intrauterine cavity is T-shaped, its elimination by hysteroscopy surgery may be recommended to increase the chance of pregnancy and to reduce the risk of a possible miscarriage or premature birth during pregnancy. In recurrent IVF treatment failures, diagnostic hysteroscopy may also be performed to look for a problem that cannot be seen on ultrasound or HSG testing.

DOES LAPAROSCOPY INCREASE THE CHANCES OF PREGNANCY?

As it is known, another important finding that can lead to deformity and dysfunction in the uterus is myomas. In fact, one out of every 4 women has myoma.

Of course, surgery is not necessary for every myoma. If it does not cause an obstacle to having children, there is no need for surgical removal of the myomas. However, if the myomas affect the uterine cavity, if they have a structure that will disrupt the blood supply of the intrauterine tissue, or if their size is over 4 cm, they may need to be surgically removed. Laparoscopic or open surgery is entirely up to the surgeon's decision. At least 3 months should be waited for pregnancy after each surgery.

As it is known, laparoscopy is a closed surgery method. This method, which is performed through small incisions in the abdomen, is especially preferred for problems in the fallopian tubes. An example of this is the accumulation of fluid in the fallopian tubes as a result of obstructions or obstructions due to structural anomalies. Because the accumulated fluid can turn into inflammation over time and flow into the uterus. This is a factor that weakens the adhesion strength of the embryo and disrupts the healthy environment of the intrauterine tissue. With laparoscopy, it is possible to get rid of these fallopian tubes, which do not benefit or even harm the pregnancy, and the chance of pregnancy increases two and a half times.

IN WHICH CONDITIONS SHOULD CHOCOLATE CYSTS (ENDOMETRIOMA) BE REMOVED?

Surgical procedures are also successfully performed for ovarian problems. Many ovarian cysts can be removed through laparoscopy. However, the situation is a little different for chocolate cysts. These cysts negatively affect egg formation and quality. Therefore, for those who want to have a child, these chocolate cysts that damage the egg reserves should be investigated thoroughly, the surgery should be decided only under certain conditions by considering the risks. If the patient's ovarian reserve is in a very good condition and the age is young and the period of infertility is short, these cysts can be removed by laparoscopy. However, even if all these conditions are met, IVF treatment can be started as a priority and success can be achieved. Bilateral or previously operated chocolate cysts should not be re-operated as much as possible. In addition, when cancer is suspected and there is a cyst that prevents access to the ovaries during IVF treatment, laparoscopy may be considered to remove the cysts. However, it should be remembered that in any case, surgeries may cause some decrease in ovarian reserve. It is recommended that couples use the chance of natural pregnancy for one year in the postoperative period, and if no conception occurs after this period, IVF treatment can be started.

AFTER SURGERIES...

After the hysteroscopy surgery, if a tissue is formed for example, the tissue is expected to repair itself with a two-month hormone treatment to prevent adhesions in the area. However, if a polyp has been removed, IVF treatment can be started the very next month. If a myoma is to be removed by laparoscopic or open surgery, pregnancy for at least three months will not be recommended. There is no waiting period after surgery for inflammation in the fallopian tubes or surgery for ovarian cysts.