Infertility is defined as the failure to conceive after one year of unprotected sexual intercourse. But a diagnosis of infertility does not mean that becoming pregnant is impossible.
Nearly 90 percent of infertility cases are treatable with medical therapies ranging from drug treatment and surgery to advanced reproductive technologies such as in vitro fertilization (IVF).
Reproductive Science Center of New Jersey offers many surgical treatment options. Robotic myomectomy: the surgical technique that removes uterine fibroids that can contribute to pelvic pain, vaginal bleeding, or infertility.
Robotic Surgery for Infertility: RSCNJ fertility specialists use minimally invasive Da Vinci robotic surgery & laparoscopy for women with infertility as effective uterine fibroid treatment.
Listen in as Dr. Alan Martinez discusses these and other surgical techniques to help women conceive and carry a pregnancy to term.
The Role of Reproductive Surgery in Treating Infertility
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 8/28/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): There are many incidences where reproductive surgery can make a difference in a woman’s fertility and the ability to conceive and a carry baby to term. My guess today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. What are some of those instances where reproductive surgery could really make a difference in a couple’s ability to conceive a baby?
Dr. Alan Martinez (Guest): Thank you for having me today. I appreciate the opportunity to talk. In an evaluation for infertility, a women undergoes several tests and that includes looking at both the uterus itself and where an embryo would implant, as well as the tubal architecture—the fallopian tubes. So, those are two of the common places where we can find some pathology and that pathology may need to be corrected in order to increase a woman’s chances of conceiving.
Melanie: What are some of the surgical treatment options that you offer at Reproductive Science Center of New Jersey?
Dr. Martinez: We offer several types of surgeries. We offer hysteroscopy, where you essentially address problems within the uterine cavity, such as uterine polyps or fibroids which are different types of growths that may be found in the uterus during infertility testing, specifically with a sonohystogram which is when we look at the cavity of the uterus or a hysterosalpingogram, which also looks at the cavity of the uterus. So, hysteroscopy is one of the procedures. Another thing we can do is we can do minimally invasive surgical techniques, such as a laparoscopy. This can either be done with hand-held instruments or through robotic means where we use a robot that has arms that we control in a very precise manner to potentially address issues surrounding the ovaries, surrounding fallopian tubes, and more structural things found within a woman’s pelvis during her infertility exam. And then, finally, we also sometimes do open surgeries where we do a larger abdominal incision to deal with larger problems within the uterus, such as large fibroids or others things that may need better access and removal within the abdomen. Lastly we also offer, in some cases, for some individuals, tubal reversal procedures. For people that have prior sterilization procedure, we may actually repair and reconnect the tubes and attempt to allow a woman to conceive.
Melanie: Let’s go back to hysteroscopy for just a second. Tell us a little bit about the procedure. Is this an outpatient procedure? What is it like for the woman to undergo some of these?
Dr. Martinez: A hysteroscopy can be done both as an inpatient and outpatient setting and it really depends upon the specific pathology or the issues that we’re trying to fix. In many cases, a woman will have the hysteroscopy under either light anesthesia or under general anesthesia to allow the surgeon to completely remove any sort of structural things that are inside the cavity of the uterus. So, what it involves is, it’s a same-day procedure, and if it’s done in the office, then you come in and you undergo some pain medication and it’s done while you are awake. In the case of the hospitals, you have generalized anesthesia or light anesthesia for about 30-45 minutes at most, and then you go home the same day. You recover and usually afterwards, it leads to very minimal bleeding such as at the end of a period, or even no bleeding, and just some mild cramping. But, women do very well with this procedure so they’re back at their normal activities within the next day.
Melanie: If you’re using that to view the uterine cavity then if you find stuff--adhesions, fibroids, scarring--can you treat them at the same time or is that a separate thing?
Dr. Martinez: No, it is “see and treat.” So, we have diagnostic hysteroscopies where you just look and you find pathology, but we have, in today’s world, there are fancy instruments that we can use and several different ones which allow us to perform an operative hysteroscopy. So, we remove the polyp, we remove the fibroids. They’re devices that cut into these tissues to normalize the lining of the uterus, to make it hospitable to an embryo. We can do that and then any specimens are sent off to pathology for analysis. And, in the vast, vast majority, greater than 99% of the time, all of the specimens that we find are of a benign nature and they’re not cancerous.
Melanie: Tell us a little bit about robotic surgery for infertility in the da Vinci Surgical System?
Dr. Martinez: The da Vinci is a form of laparoscopy where you make several small incisions, oftentimes less than one centimeter or 10 millimeters, and it allows precise surgical movements that, prior to the development of the da Vinci robotic surgery device, we were limited as far as general surgeons and as far as reproductive surgeons. So, what happens is these small instruments go into the patient’s abdomen, the abdomen is distended with fluid, and the fluid will actually allow you to work within the cavity of the abdomen itself. Using precise robotic handheld modules we can precisely control in very millimeter-sized increments of precision move these instruments to allow us to perform really amazing surgery to where we can repair tubes, we can take out ovarian cysts, we can repair adhesions, and really restore the normal anatomy of a woman’s pelvis. Previously, we wouldn’t have had the dexterity, but the robot allows us to really do that.
Melanie: What are some of the benefits for the patient?
Dr. Martinez: Any time you use minimally invasive surgery, which are just small incisions on the abdomen, it is a quicker surgery in more cases, it allows more precise development and precise attention to the cavity of the abdomen and fixing the pathology, it also results in less bleeding for patients. So, it’s safer. Overall, the recovery results in much less pain. So, patients are back on their feet much more quickly.
Melanie: When we’re talking about a myomectomy for fibroids, this type of procedure seems pretty common. Do a lot of women suffer from fibroids?
Dr. Martinez: Yes. Fibroids are quite common. Greater than 50% of women will have a fibroid uterus that is found some time in their life or at a later time when they start having medical issues. So, it’s a very common thing and oftentimes in the world of fertility it can impact a woman’s ability to conceive. So, it is a common surgery.
Melanie: This is one you can also do robotically, yes?
Dr. Martinez: Correct. In selected patients, yes. It allows us to take out fairly large fibroids out of a small incision with minimal blood loss and quicker recovery time.
Melanie: Is there a risk that the fibroids will come back, Dr. Martinez?
Dr. Martinez: Yes. Fibroids are benign, smooth muscle tumors that grow within the uterus. They respond to estrogen, which is a product of the ovaries themselves. Each of the fibroids are independent growths, so although we may do a surgery and do a myomectomy, there may be other fibroids that we can’t see or not yet developing that may recur afterwards. However, in most cases, women have just a few solitary fibroids and it’s only when they really get to a certain size or a specific location within the uterus that they really impact fertility. So not all women with fibroids need to have myomectomies, but those that have larger ones or fibroids that are found within the cavity of the uterus, those are the ones that need to be addressed in these patients.
Melanie: At the beginning, you mentioned tubal ligation reversal. Many women have assumed that if they’ve had tubal ligation this is an irreversible procedure. Speak to that procedure for a minute.
Dr. Martinez: When a woman presents to our office with a history of a tubal surgery, what we need to do is, we need to assess the length of the tube that remains, the type of tubal surgery, to see whether they are candidates. And, what we can actually do through minimally invasive means is that we can go and actually take out the occluded part of the fallopian tube and then reapproximate the tube so that it is then open. And for some women, especially women that are of a younger, reproductive age, and they have a high chance of pregnancy, this may be an option. It’s not an option in all patients and that’s why it’s discussed on individual basis. But, oftentimes in women that have had previous tubal surgery, if you are not to address the tubes or either proceed with fertility treatments, then those patients must undergo in vitro fertilization. So, in some cases, in the select patients, we can avoid that.
Melanie: In just the last few minutes, wrap it up for us, Dr. Martinez, about what you tell women everyday should they need a surgical procedure for their fertility, and why they should come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: Here at the Reproductive Science Center of New Jersey, we take patients and we meet you in an individualized fashion, take an extensive history to find out if and what surgery is best for you, we counsel you, and we work together as a team to provide the care that you need. Many of these surgeries have a very quick recovery time and, in many cases, they can result in increase in your chances of conceiving to a large degree. So, we’re happy to meet with you and we look forward to calling and setting up an appointment to discuss these issues with you.
Melanie: Thank you so much for being with us today. What great information! You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey, RSC NJ. For more information, you can go to fertilitynj.com. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): There are many incidences where reproductive surgery can make a difference in a woman’s fertility and the ability to conceive and a carry baby to term. My guess today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. What are some of those instances where reproductive surgery could really make a difference in a couple’s ability to conceive a baby?
Dr. Alan Martinez (Guest): Thank you for having me today. I appreciate the opportunity to talk. In an evaluation for infertility, a women undergoes several tests and that includes looking at both the uterus itself and where an embryo would implant, as well as the tubal architecture—the fallopian tubes. So, those are two of the common places where we can find some pathology and that pathology may need to be corrected in order to increase a woman’s chances of conceiving.
Melanie: What are some of the surgical treatment options that you offer at Reproductive Science Center of New Jersey?
Dr. Martinez: We offer several types of surgeries. We offer hysteroscopy, where you essentially address problems within the uterine cavity, such as uterine polyps or fibroids which are different types of growths that may be found in the uterus during infertility testing, specifically with a sonohystogram which is when we look at the cavity of the uterus or a hysterosalpingogram, which also looks at the cavity of the uterus. So, hysteroscopy is one of the procedures. Another thing we can do is we can do minimally invasive surgical techniques, such as a laparoscopy. This can either be done with hand-held instruments or through robotic means where we use a robot that has arms that we control in a very precise manner to potentially address issues surrounding the ovaries, surrounding fallopian tubes, and more structural things found within a woman’s pelvis during her infertility exam. And then, finally, we also sometimes do open surgeries where we do a larger abdominal incision to deal with larger problems within the uterus, such as large fibroids or others things that may need better access and removal within the abdomen. Lastly we also offer, in some cases, for some individuals, tubal reversal procedures. For people that have prior sterilization procedure, we may actually repair and reconnect the tubes and attempt to allow a woman to conceive.
Melanie: Let’s go back to hysteroscopy for just a second. Tell us a little bit about the procedure. Is this an outpatient procedure? What is it like for the woman to undergo some of these?
Dr. Martinez: A hysteroscopy can be done both as an inpatient and outpatient setting and it really depends upon the specific pathology or the issues that we’re trying to fix. In many cases, a woman will have the hysteroscopy under either light anesthesia or under general anesthesia to allow the surgeon to completely remove any sort of structural things that are inside the cavity of the uterus. So, what it involves is, it’s a same-day procedure, and if it’s done in the office, then you come in and you undergo some pain medication and it’s done while you are awake. In the case of the hospitals, you have generalized anesthesia or light anesthesia for about 30-45 minutes at most, and then you go home the same day. You recover and usually afterwards, it leads to very minimal bleeding such as at the end of a period, or even no bleeding, and just some mild cramping. But, women do very well with this procedure so they’re back at their normal activities within the next day.
Melanie: If you’re using that to view the uterine cavity then if you find stuff--adhesions, fibroids, scarring--can you treat them at the same time or is that a separate thing?
Dr. Martinez: No, it is “see and treat.” So, we have diagnostic hysteroscopies where you just look and you find pathology, but we have, in today’s world, there are fancy instruments that we can use and several different ones which allow us to perform an operative hysteroscopy. So, we remove the polyp, we remove the fibroids. They’re devices that cut into these tissues to normalize the lining of the uterus, to make it hospitable to an embryo. We can do that and then any specimens are sent off to pathology for analysis. And, in the vast, vast majority, greater than 99% of the time, all of the specimens that we find are of a benign nature and they’re not cancerous.
Melanie: Tell us a little bit about robotic surgery for infertility in the da Vinci Surgical System?
Dr. Martinez: The da Vinci is a form of laparoscopy where you make several small incisions, oftentimes less than one centimeter or 10 millimeters, and it allows precise surgical movements that, prior to the development of the da Vinci robotic surgery device, we were limited as far as general surgeons and as far as reproductive surgeons. So, what happens is these small instruments go into the patient’s abdomen, the abdomen is distended with fluid, and the fluid will actually allow you to work within the cavity of the abdomen itself. Using precise robotic handheld modules we can precisely control in very millimeter-sized increments of precision move these instruments to allow us to perform really amazing surgery to where we can repair tubes, we can take out ovarian cysts, we can repair adhesions, and really restore the normal anatomy of a woman’s pelvis. Previously, we wouldn’t have had the dexterity, but the robot allows us to really do that.
Melanie: What are some of the benefits for the patient?
Dr. Martinez: Any time you use minimally invasive surgery, which are just small incisions on the abdomen, it is a quicker surgery in more cases, it allows more precise development and precise attention to the cavity of the abdomen and fixing the pathology, it also results in less bleeding for patients. So, it’s safer. Overall, the recovery results in much less pain. So, patients are back on their feet much more quickly.
Melanie: When we’re talking about a myomectomy for fibroids, this type of procedure seems pretty common. Do a lot of women suffer from fibroids?
Dr. Martinez: Yes. Fibroids are quite common. Greater than 50% of women will have a fibroid uterus that is found some time in their life or at a later time when they start having medical issues. So, it’s a very common thing and oftentimes in the world of fertility it can impact a woman’s ability to conceive. So, it is a common surgery.
Melanie: This is one you can also do robotically, yes?
Dr. Martinez: Correct. In selected patients, yes. It allows us to take out fairly large fibroids out of a small incision with minimal blood loss and quicker recovery time.
Melanie: Is there a risk that the fibroids will come back, Dr. Martinez?
Dr. Martinez: Yes. Fibroids are benign, smooth muscle tumors that grow within the uterus. They respond to estrogen, which is a product of the ovaries themselves. Each of the fibroids are independent growths, so although we may do a surgery and do a myomectomy, there may be other fibroids that we can’t see or not yet developing that may recur afterwards. However, in most cases, women have just a few solitary fibroids and it’s only when they really get to a certain size or a specific location within the uterus that they really impact fertility. So not all women with fibroids need to have myomectomies, but those that have larger ones or fibroids that are found within the cavity of the uterus, those are the ones that need to be addressed in these patients.
Melanie: At the beginning, you mentioned tubal ligation reversal. Many women have assumed that if they’ve had tubal ligation this is an irreversible procedure. Speak to that procedure for a minute.
Dr. Martinez: When a woman presents to our office with a history of a tubal surgery, what we need to do is, we need to assess the length of the tube that remains, the type of tubal surgery, to see whether they are candidates. And, what we can actually do through minimally invasive means is that we can go and actually take out the occluded part of the fallopian tube and then reapproximate the tube so that it is then open. And for some women, especially women that are of a younger, reproductive age, and they have a high chance of pregnancy, this may be an option. It’s not an option in all patients and that’s why it’s discussed on individual basis. But, oftentimes in women that have had previous tubal surgery, if you are not to address the tubes or either proceed with fertility treatments, then those patients must undergo in vitro fertilization. So, in some cases, in the select patients, we can avoid that.
Melanie: In just the last few minutes, wrap it up for us, Dr. Martinez, about what you tell women everyday should they need a surgical procedure for their fertility, and why they should come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: Here at the Reproductive Science Center of New Jersey, we take patients and we meet you in an individualized fashion, take an extensive history to find out if and what surgery is best for you, we counsel you, and we work together as a team to provide the care that you need. Many of these surgeries have a very quick recovery time and, in many cases, they can result in increase in your chances of conceiving to a large degree. So, we’re happy to meet with you and we look forward to calling and setting up an appointment to discuss these issues with you.
Melanie: Thank you so much for being with us today. What great information! You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey, RSC NJ. For more information, you can go to fertilitynj.com. This is Melanie Cole. Thanks for listening.