Vanderbilt Center for Women's Health

Infertility Procedures


Our skilled specialists perform the following minimally-invasive procedures. Click on the links below to learn more.

 

Tubal Reversal

Some women change their minds after having a tubal sterilization operation. Although tubal sterilization is the most effective and permanent form of birth control, it can be reversed surgically. This is done through an outpatient, low-cost procedure called microsurgical tubal reanastomosis (or tubal reversal).

Tubal reversal is effective in more than 70-80% of women. Success depends on where your tubes were cut, whether scar tissue formed, and the length of the remaining healthy fallopian tubes.

Many women choose IVF (invitro fertilization) over tubal reversal. A tubal reversal has benefits, though. After a tubal reversal, you typically don’t need fertility drugs to get pregnant. This lowers your chances of having multiple babies. Also, once you have a tubal reversal, you can conceive more than one child without having to repeat the tubal reversal procedure.


 

Hysteroscopy

In the procedure called hysteroscopy, we place a tiny telescope through your cervix, directly into your uterine cavity. No incisions are needed.

During the procedure, we will evaluate abnormalities inside the uterine cavity such as:

  • scar tissue (from prior infection or pregnancy),
  • fibroids,
  • polyps, or
  • uterine malformations (such as uterine septum).

These can be treated surgically at the same time.

Recovering from a hysteroscopy generally only takes 24-48 hours, since no incision is required. The risks involved with hysteroscopy are very minimal.

A hysteroscopy usually takes 30-45 minutes to perform. Following the surgery itself, your recovery in the recovery room generally lasts about 2-3 hours; shortly thereafter, you would then be discharged home.

In less than 1% of cases, patients have to be admitted to the hospital for observation, pain management, or other reasons.



Laparoscopy

Laparoscopy is the most direct way to assess what’s going on in your pelvis. It’s also the least invasive. You will be put under general anesthesia so you don’t feel anything. Then we insert a tiny telescope (the laparoscope) through your navel. This lets us see your internal pelvic anatomy, and if necessary, correct some conditions

Often scar tissue endometriosis, fibroids, ovarian cysts or other pelvic disorders can be the main causes of infertility, miscarriage, pelvic pain, or abnormal bleedings. A laparoscopy will determine what is involved—your cervix, uterus, fallopian tubes, ovaries or entire pelvis. Laparoscopy usually provides the most effective treatment of any disorder.

What to Expect

The average laparoscopy/hysteroscopy takes between 60 and 90 minutes. Afterward, you will be in the recovery room for 2-3 hours. Then you will be discharged to go home. In less than 1% of surgeries, admission to the hospital is necessary for observation or pain management.

You should get a good night’s sleep the night before a laparoscopy. It is not necessary to donate blood in advance, since the chance of transfusion is very low. Remember to eat or drink nothing after midnight the night before surgery. It is okay to brush your teeth the following morning with little water.

You should arrive for your surgery one hour before its scheduled time. Wear comfortable clothing and no nail polish. This is so that the fingertip monitor you will wear can function optimally. The person accompanying you can wait with you until minutes before the surgery is to begin. He/she may join you in the recovery room shortly after the surgery is over.

Immediately after the surgery, your doctor will explain the findings (if you wish) to your husband or partner. After anesthesia, you will not remember much of the conversation. We will explain the findings in detail at your post-operative visit 1 to 2 weeks later in the office. We will discuss the next steps in our treatment plan at that time.

What kind of recovery should be expected?
Following the laparoscopy, 3-4 days of recovery is the average time most patients need to feel basically back to normal. You may feel some abdominal pain for a few days. Take the pain medicine prescribed for you before the pain gets severe. The anesthesia effect (feeling “washed out”) can also last several days. Most women can return to work after 3-4 days.

Insurance Concerns
Most insurance companies cover this procedure. Our financial counselors will assist you with any questions you may have regarding insurance coverage. Each plan varies, and you need to know the terms of your specific policy in advance. Pre-certification for surgery is required.



Intrauterine Insemination (IU)

Intrauterine insemination (USI) is also called artificial insemination. In this procedure, millions of sperm are placed directly into your uterus when you are most fertile. This is planned for immediately before and during ovulation. These sperm cells have been “washed” with special solutions, then concentrated. This increases the number of sperm that make it to the fallopian tube where fertilization takes place. This improves your chances of conceiving.

IUI can be performed with or without your using fertility drugs. When fertility drugs are used, this therapy is called controlled ovarian hyperstimulation (COH), ovulation induction (OI) or superovulation. IUI with COH generally increases the chance of pregnancy.

Who benefits from IU?

  • People who can benefit from IUI are couples:
  • with no known cause of infertility
  • in which the male has mild to moderate decreased semen quality
  • in which the woman has an ovulatory disorder that responds well to fertility medication
  • with women who have mild endometriosis
  • with women using donor semen

How IUI is performed
We monitor the woman’s ovulation with home ovulation predictor kits and clinic ultrasounds and blood tests. We monitor her for any signs of adverse effects of fertility drugs. We also give the woman a hormone injection of human chronic gonadotropin (hCG) to regulate ovulation.

The man provides a semen sample on the morning of insemination. This sample is prepared and then inserted through the woman’s cervix and into the uterus. This is done through a thin plastic catheter. The procedure takes place in our clinic. It is relatively painless.

Possible Complications
Complications of IUI can include infection and uterine cramping. However, they are rare. Also, fertility medications have potential side effects, including ovarian hyperstimulation syndrome and multiple pregnancies.

If no pregnancy is achieved after 3 IUI’s, our specialists may recommend more advanced reproductive therapies such as IVF.

Success with IUI depends on what’s causing the infertility, the woman’s age, and total sperm count. If the count is good and the woman’s fallopian tubes are healthy, conception rates for IUI and COH are approximately 15-20 percent per cycle.


 

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(615) 343-5700


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