As fertility for a woman declines rapidly with age, a married couple who are ready to start a family should do so quickly. In general, a young and healthy couple can try naturally for 1-2 years before consulting a fertility specialist for review. The older woman (above 37 years) or those with symptoms suggestive of disorders of the reproductive system should seek help earlier. Significant symptoms include irregular menstrual cycles, painful menstruation, painful intercourse, painful defecation or chronic pelvic pain. Likewise, women with any pre-existing gynaecological conditions or hormonal disorders should also check with their gynaecologist regarding their ability to conceive naturally.
Pre-conception and fertility assessment may include the following areas:
- Full blood count and thalassemia screen
- Test of Rubella immunity (chickenpox and hepatitis B can be done too)
- Female’s ovulation status
- Detailed examination of the pelvis
- Fallopian tube patency
- Shape of womb cavity
- Sperm count
For selected couples, a detailed examination of the female pelvis with laparoscopy (keyhole surgery) may be recommended, especially if bedside examination reveals possible conditions that can be treated during laparoscopy.
02 LAPAROSCOPY or KEYHOLE SURGERY
Laparoscopy, also commonly referred to as keyhole surgery, is integral to the state-of-the-art gynaecology and fertility services provided at STO+G Practice. This minimally invasive route of surgery allows the surgeon access to the woman’s pelvis, to confirm the presence of gynaecological conditions, as well as to determine the cause(s) of infertility. Most surgical procedures required to treat these conditions can be accomplished via laparoscopy itself, making it a truly one-stop see-and-treat procedure for infertility.
The benefits of laparoscopy (over conventional open surgery) includes shorter hospitalization, faster recovery, less blood loss, pain and internal scarring, more precise dissection allows for less damage to surrounding tissue during surgery (this is especially important for fertility cases). Furthermore, the cosmetic effect of the “keyhole” wounds are far better than that of conventional open surgery.
Dr Steven Teo is trained in Sydney to perform advanced laparoscopic surgery to achieve the greatest therapeutic effects intended. He is actively involved in teaching laparoscopy at various workshops and restructured hospitals. Common laparoscopic procedures performed by Dr Steven Teo to treat infertility include:
- Removal of fibroids
- Removal of ovarian cysts
- Removal of endometrial polyps
- Pelvic clearance of endometriosis (targeted peritonectomy)
- Reconstruction or re-joining of damaged fallopian tubes
Besides infertility, Dr Steven Teo also utilises laparoscopy to treat other gynaecological diseases, such as removal of diseased ovaries, fallopian tubes, or even the entire womb. For selected cases, he is also able to perform these procedures with a single keyhole buried in the belly button, resulting in an essentially scarless surgery for the best cosmetic outcome.
03 INFERTILITY TREATMENT
As some women are affected by structural problems of their reproductive tract, surgical correction may be the solution to their infertility, or it may complement other modes of treatment to optimise the chance of a successful pregnancy. Commonly encountered conditions that will require surgery include endometriosis, fibroids, ovarian cysts, scarring / blockage of fallopian tubes and disorders of the womb lining. The clearance of endometriosis from the pelvis of the woman may render her fertile again, with or without additional therapy. The meticulous conservation of healthy egg-bearing tissue of the ovary during cyst removal will ensure that the woman’s future fertility is not compromised. The repair or rejoining of obstructed fallopian tubes is a highly complicated procedure that demands the the most of a surgeon’s skills at keyhole surgery; success, however will reward with the possibility of natural pregnancy (without IVF).
Not being able to ovulate naturally is a challenge faced by many infertile women, especially those without regular menstrual cycles. Ovulation induction is a simple treatment with the aim of releasing 1-3 matured eggs each month, while the couple commits to having regular intercourse during the fertile window.
Super-Ovulation Intra-Uterine Insemination (SOIUI) is a fertility treatment, commonly used to help couples with milder fertility issues. It starts with the stimulation of eggs to maturity, leading to eventual release from the ovary (ovulation). This is followed by the processing of the partner’s semen and depositing it directly into the womb. Fertilization and pregnancy will take place naturally. Once pregnancy is confirmed on urine or blood test, a scan will be performed to determine the site and number of pregnancy sacs.
IVF / ICSI
Assisted reproduction (also known as In-Vitro Fertilization) has evolved over the past 3 decades with increasing success rates. It involves the following essential steps:
- Controlled stimulation of the ovaries
- Harvesting of matured eggs
- Fertilization of eggs with sperm
- Transfer of embryos
- Supporting the pregnancy
As the eggs present within the ovaries are immature, they have to be stimulated before harvesting. Variable degrees of stimulation are practiced, depending on the profile of the individual woman. During stimulation, it is crucial to monitor the eggs with regular ultrasound scans. When matured, the eggs are harvested under ultrasound guidance and processed in the laboratory. The partner’s semen is processed simultaneously to select suitable sperm for fertilization. The fertilized eggs become embryos and will be transferred into the womb for implantation. After the transfer, the womb lining needs to be supported with hormones. A pregnancy test will be performed 2 to 3 weeks after transfer. If unsuccessful, extra embryos frozen during the treatment cycle may be thawed in future for transfer, without the need for stimulation of eggs and harvesting.
04 REVERSAL OF TUBAL LIGATION
This is a highly demanding keyhole procedure that tests the skills of the surgeon. The ligated fallopian tubes will have the damaged segment removed and the remaining healthy portions rejoined. If successful, the couple can proceed to conceive naturally.
05 SURGICAL SPERM RETRIEVAL
Occasionally, obstruction of the male reproductive tract results in the ejaculated semen containing no sperm at all. In such scenario, attempts can be made to retrieve live sperm from the testes surgically. If successful, the sperm obtained can be used for ICSI to create embryos for transfer into the wife’s womb. The alternative to this procedure is to use donor’s sperm for IVF.