Surgical Treatment Options for Female Infertility

Abstract

Infertility, defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples. An infertility evaluation may be offered to any patient who by definition has infertility or is at high risk of infertility. Hysterosalpingography, hysterosalpingo-contrast sonography, saline infusion sonohysterography, hysteroscopy, laparoscopy, and bacteriological and endocrinological examinations that will be made after these studies aim to focus more on the causes of infertility. With the development of assisted reproductive technology, the need for major reproductive surgery, which may be necessary for the primary treatment of infertility, has decreased over the years. Surgical methods are mainly considered as laparoscopic and hysteroscopic techniques. However, laparotomy is also rarely required and may be needed in cases such as adhesions, mass lesions, unsuccessful surgeries, or emergency surgery. When a surgical treatment is planned for infertile patients who required surgery, it is very crucial that the procedure should be performed by experienced surgeons. In this review, pathologies that require surgery for infertility treatment and surgical methods that can be applied to infertile patients were discussed, rather than medical treatments.

Keywords

• Infertility
• laparoscopy
• hysteroscopy

Kadın İnfertilitesi için Cerrahi Tedavi Seçenekleri

Abstract

İnfertilite 35 yaşın altındaki kadınlarda 12 ay veya 35 yaşın üstündeki kadınlarda 6 ay korunmasız cinsel ilişkiye veya terapötik donör inseminasyonuna rağmen gebe kalamama hali olarak tanımlanıp çiftlerin %15’ini etkileyen durumdur. Tanım gereği infertilitesi olan veya infertilite riski yüksek olan herhangi bir hastaya infertilite değerlendirmesi önerilebilir. Histerosalpingografi, histerosalpingo-kontrast sonografi, salin infüzyon sonohisterografi, histereskopi, laparoskopi ve bu çalışmalardan sonra yapılacak bakteriyolojik ve endokrinolojik incelemeler ile infertilite nedenlerine daha fazla odaklanılması amaçlanmaktadır. Yardımcı üreme teknolojisinin gelişmesiyle birlikte infertilitenin birincil tedavisi için gerekli olabilecek majör üreme cerrahisine olan ihtiyaç yıllar içinde azalmıştır. Cerrahi yöntemler temel olarak laparoskopik ve histeroskopik teknikler olarak kabul edilmektedir. Ancak laparotomi de nadiren de olsa gereklidir ve adezyonlar, kitle lezyonları, başarısız ameliyatlar veya acil ameliyat gibi durumlar söz konusu olduğunda ihtiyaç duyulabilir. Ameliyat gerektiren infertil hastalarda cerrahi bir tedavi planlanırken işlemin deneyimli cerrahlar tarafından yapılması çok önemlidir. Bu derlemede, medikal tedavilerden ziyade infertilite tedavisi için cerrahi gerektiren patolojiler ve infertil hastalarda uygulanabilecek olan cerrahi yöntemler tartışılmıştır.

Keywords

• İnfertilite
• laparoskopi
• histeroskopi

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