Infertility problems may be caused by many different factors, from problems in the reproductive anatomy such as blockages in female or male reproductive ducts or abnormal morphology of the uterine cavity, to some conditions that develop over time, such as endometriosis or myomas. Physical complications can often be resolved by surgical procedures. Your doctor may recommend one of the following procedures before suggesting doing a specific fertility treatment.

  1. Hysteroscopy
  2. Laparoscopy
  3. Laparotomy
  4. Testicular biopsy
  5. Micro Tese
  1. Histeroscopy
  2. What is hysteroscopy?
    Hysteroscopy is a procedure that allows the gynecologist to look inside the uterus. It is considered a minor surgery, it does not involve any incision in the skin and, usually, the patient is discharged the same day.

    What is the purpose of the hysteroscopy?
    This procedure is used to diagnose and treat some of the problems that cause infertility (spontaneous miscarriages, uterine adhesions, abnormal menstrual bleeding, scars in the uterine cavity from previous surgical procedures, uterine polyps, myomas, etc.)

    What is the procedure?
    Hysteroscopy is named after the instrument that is used to visualize the uterus. The hysteroscope is a long, very thin tube, that has a built in display device that is inserted through the vagine and cervix into the uterine cavity. The uterine cavity is dilated with a fluid that is injected and allows you to see clearly the internal structure, the uterine walls and the permeability of the fallopian tubes. This procedure is performed in the operating theatre, usually under local anaesthesia or sedation to make it as comfortable as possible for the patient.

  3. Laparoscopy
  4. What is laparoscopy?
    A diagnostic laparoscopy is a procedure in which the doctor examines organs and tissues inside the abdomen using a laparoscope.

    What is the purpose of the laparoscopy?
    Diagnostic laparoscopy is recommended for the evaluation of the uterine cavity, fallopian tubes, ovaries and pelvic area from the inside. In many cases, patients with fertility problems need this procedure in order to obtain a full assessment.

    This procedure is usually carried out after the fertility evaluation, prior to diagnosis, however, when there is pain, a previous history of infection or an abnormal ultrasound, may be indicated before completing the evaluation.

    What is the procedure?
    A laparoscopy is carried out using an instrument called laparoscope which gives its name to the procedure. It is a thin metal tube with a tiny and very light camera at the end, which is connected to a high resolution monitor so that the surgeon and his assistants can control the procedure all the time . It is considered minimally invasive surgery.

  5. Laparotomy
  6. What is laparotomy?
    Exploratory laparotomy or abdominal surgery exploration is recommended to diagnose an abdominal disease that can not be determined using other techniques.

    What is the purpose of the laparotomy?
    The purpose of this procedure is to obtain an accurate diagnosis from the inside of the abdominal cavity to treat any anatomical and functional abnormalities.

    What is the procedure?
    This procedure is performed under general anaesthesia. The cavity is explored through an abdominal incision. The incision or laparotomy to be carried out will depend mainly on the anatomy of the abdominal wall and the characteristics of the condition requiring surgery. If an abnormality is detected during the exploration, the surgeon would try to resolve this at the same time. Tissue samples can be taken for a later biopsy.

  7. Testicular biopsy
  8. What is a testicular biopsy?
    A testicular biopsy is an outpatient surgical procedure which is performed to try to solve severe abnormalities in semen quality.

    What is the purpose of a testicular biopsy?
    Se realiza con el fin de extraer espermatozoides en hombres con ausencia de ellos en el eyaculado.
    It is performed in order to obtain sperm in men with absence of them in the ejaculate. There are two types of azoospermia depending on the cause of the lack of sperm in the semen: secretory azoospermia (also called non-obstructive azoospermia), in which the testicles are unable to produce sperm; and obstructive azoospermia where the testicles produce sperm but there is a problem in the vas deferens which are responsible for transporting them to the ejaculate.

    What is the procedure?
    A small incision is made to remove internal portions of testis to determinate if there are any sperm. While the surgeon removes internal portions of testis, the reproductive specialist examines them with the microscope and looks for sperm. When he considers that he has found sufficient, the doctor will close the incision. It is performed under local anaesthesia and sedation. The patient is allowed to go home a few hours after the surgery as directed by the doctor.

    Once sperm are found, the reproduction treatment most indicated is IVF with ICSI, as this technique allows the selection of sperm with better morphology and the injection into the egg/s thus providing the highest possibility of achieving fertilisation.

  9. Micro Tese
  10. What is Micro Tese?
    Micro Tese is a surgical technique that has been developed to improve sperm detection in testes of men with poor sperm production (secretory azoospermia). It has been found that many men who have been diagnosed with non-obstructive azoospermia, even though it is due to pathological conditions, have small areas of sperm production in the testes.

    What is the purpose of performing a Micro Tese?
    Our challenge is to find areas where there is sperm in the testis and removed them to use them in a in vitro fertilization treatment. This technique allows us to direct the biopsy to the best areas of the testis and increase the chance of finding sperm removing smaller amounts of tissue and causing less damage than a random testicular biopsy.

    Micro Tese is currently recognized as the best method for finding sperm in men with secretory azoospermia.

    What is the procedure?
    Using a surgical microscope to examine the deferens tubules at the time of the testicular biopsy, the best tubules are selected. Once the sample is removed, the tubules are opened in a Petri dish containing sperm wash media and the search for sperm begins examining the specimen under a microscope. The search form sperm can take up to four or five hours as it is a very delicate process. Once they are found, the sperm are then either incubated and introduced into the eggs or frozen to be introduced into the egg in the future.