American Medical Association Family Medical Guide - American Medical Association [269]
Surgery
Doctors perform surgery to remove fibroids (see page 867) and to remove tissue deposits caused by endometriosis (see page 870). They can sometimes surgically repair blocked fallopian tubes using one of three procedures—tubal cannulation, adhesiolysis, or tubal reanastomosis. In tubal cannulation, the surgeon inserts a thin tube (called a cannula) into the obstructed fallopian tube to open it. In adhesiolysis, the doctor removes scar tissue near the obstructed fallopian tube and ovary. Tubal reanastomosis joins the two severed ends of a fallopian tube after a blockage has been surgically removed; this procedure is also used to try to reverse a tubal ligation (see page 476). In women who have a structural defect such as a wall in the center of their uterus, surgeons can correct the defect, improving the chances of pregnancy. Some of these surgical procedures can be performed with laparoscopy, using a lighted viewing instrument (laparoscope) and other instruments inserted through small incisions in the abdomen, which minimizes recovery time and scarring.
If a health condition such as diabetes (see page 889) or obesity is affecting your ability to become pregnant, your doctor will recommend treating the condition before trying infertility treatments.
Tubal cannulation
Tubal cannulation is a procedure to open a blocked fallopian tube. In this procedure, a wire is threaded through a thin tube (cannula) that is moved through a hysteroscope inserted through the vagina and uterus into the blockage in the fallopian tube.
Treating Infertility in Men
As with women, the infertility treatment a man receives depends on the cause of the infertility. For example, if your sperm count has been lowered by an infection or a medical condition, your doctor will provide appropriate treatment. The doctor also will strongly recommend that you discontinue any activities—including excessive smoking, drinking, or other drug use—that might be contributing to your infertility. In general, a healthy lifestyle promotes good sperm production.
Surgery
If infertility is the result of a blockage in the vas deferens (one of the tubes that carry sperm from the testicles to the urethra), surgeons can sometimes open the blockage. Doctors can correct a varicose vein in a testicle (varicocele; see page 829), which can lower sperm production, by performing surgery to tie off the affected vein.
An outpatient procedure called percutaneous embolization is as effective as traditional surgery in correcting a varicocele without the need for general anesthesia and has fewer complications. During percutaneous embolization, the surgeon inserts a small tube into a vein in the groin area through a tiny incision. He or she then injects a dye into the vein and, guided by X-ray imaging, inserts tiny metal coils or a balloon into the vein to block the flow of blood, which shrinks the varicose vein. Recovery takes less than 24 hours. Treating a varicocele improves sperm production and increases the chances of conception.
Medications
A low sperm count or poor sperm motility (movement) can sometimes result if a man’s testicles are not being stimulated enough naturally by the hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone). In this case, a doctor may recommend taking the hormone human chorionic gonadotropin (HCG) for several months to improve sperm production and motility.
Assisted Reproductive Technologies
If treatment with medication or surgery has not helped you and your partner conceive, you may want to consider additional infertility techniques known collectively as assisted reproductive technologies. These techniques use high-tech methods to fertilize an egg and transfer it to a woman’s uterus. This technology, which has helped many couples achieve a pregnancy, has improved steadily over the past several years, and the