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OBSTETRICS AND GYNECOLOGY Reproductive Endocrinology and Infertility

Reproductive Surgery

Many gynecologic problems present with abnormal bleeding or pain. If medications fail to control these symptoms patients frequently benefit from surgery. In most instances these procedures are minimally invasive and patients can return to their usual daily routines quickly, frequently the next day. At the University of Chicago we have developed expertise in minimally invasive procedures that permit the removal of abnormal ovarian cysts, fallopian tubes and uterine fibroids & polyps. Frequently, endometriosis affecting the ovaries, bowel and many other sites inside the abdominal cavity can be surgically removed, or destroyed, with a minimally invasive procedure (see laparoscopy).Reproductive surgury at the University of Chicago Hospitals All patients receive a complete physical and laboratory evaluation and the details of their personal and family histories are obtained enabling us to tailor treatments to individuals. No two patients are ever the same!

Click here for an ASRM booklet on Abnormal Uterine Bleeding

Click here to see pictures of conditions affecting female reproductive organs.

Click here for more information on uterine fibroids

Laparoscopy

This is a minimally invasive procedure which provides us with the ability to operate inside the abdominal cavity without making a large incision. Repairing tissue damaged by infection, endometriosis and scarring is possible. Even removing structures (e.g. abnormal fallopian tubes, ovarian cysts and ectopic pregnancies) is possible without enlarging the incision using these new techniques. Using these methods we have been able to reduce hospital stays and markedly diminish the pain associated with major abdominal surgery.

Myomectomy

Myomectomy is the removal of uterine fibroids. Uterine fibroids are also knows as myomas. Fibroids are the most common benign tumor of the uterus and patients usually do not experience any symptoms with these. On occasion, however, because of either size or location they can cause abnormal bleeding or pain, or both. They do not normally cause infertility unless the uterine cavity is affected or the tubes are blocked. If the fibroids are symptomatic, from pain, bleeding and/or infertility they can be removed. Depending on the location of the fibroids, this procedure can be accomplished with minimally invasive procedures. However, on occasion a more formal surgery to open the abdomen is required for access to the fibroids. This decision is dependent on the location and size of the fibroids, and the risks of a less invasive procedure, and can only be accomplished on a case by case, individualized, basis.

Hysteroscopy

This is a minimally invasive procedure that provides access to the inside of the uterine cavity. No incision is made as access is granted to the uterine cavity via the cervix. Visualizing this space enables us to specifically address and correct a problem that may be responsible for abnormal bleeding or failed implantation of a pregnancy. Specifically, we can remove a polyp, fibroid or septum present inside the uterus. Polyps are abnormal growths derived from the lining of the cavity. Fibroids can grow into the cavity from the muscular part of the uterus and a septum is a short wall at the top of the uterine cavity that results from incomplete formation of the uterus (see Recurrent Pregnancy Loss).

The Hysteroscopy can be done in the office or as an operative procedure. Your physician will decide which option is best for you.

Click here for a fact sheet on the office hysteroscopy procedure.

Endometrial Ablation

Heavy uterine bleeding (menorrhagia) is a relatively common problem. Causes of the heavy bleeding include:

If no specific cause for the bleeding can be found or if hormonal therapy does not improve the condition, endometrial ablation can be an alternative to a hysterectomy. Endometrial ablation is the destruction of the uterine lining. The procedures for endometrial ablation can be achieved through several methods including:

  1. Balloon ablation: A triangular balloon is inserted into the uterus and filled with fluid. The fluid in the balloon is heated, resulting in the destruction of the uterine lining.
  2. Electrocautery: This is performed using a small heat generating tool or a laser which destroys the lining of the uterus.
  3. Freezing: The uterine tissue is frozen, thus destroying the uterine lining.

Click here for an ASRM fact sheet on endometrial ablation.

Asherman's Syndrome

Scarring inside the uterine cavity, preventing normal implantation of the embryo is referred to as Asherman's Syndrome. It can result from previous infection, but in the United States more frequently results from Curettage (scraping or D & C) of the uterine lining.

This procedure can be performed:

In general, curettage is not a damaging procedure, but on rare occasions the lining is destroyed and scarring results. To treat this problem, a hysteroscope is inserted into the uterus and the scarring is removed under direct visualization. Subsequently the woman is treated with estrogen and a balloon is occasionally placed inside the cavity for several days, attempting to keep the cavity open while a new estrogen-stimulated lining grows back.

Mullerian Anomalies

This less frequent group of disorders results from failure of the uterus, fallopian tubes, and the upper part of the vagina to form completely. Normally, these structures result from the fusion of two canals during the embryonic development of the female infant. After the canals fuse the central walls disappear leaving a single canal at the bottom (the upper vagina, cervix and uterus) and two separate canals at the top (the Fallopian tubes).

Failure of either fusion or the disappearance of the central wall leads to a series of abnormalities ranging from minimal dimpling of the top of the uterus (a septum) to complete duplication of the upper vagina, cervix, uterus and tubes (Uterus Didelphus).

The clinical problems associated with these abnormalities are also variable and range from asymptomatic to recurrent miscarriage to severe pain from non-communication of one or more segments of the uterus. Treatments vary with the severity of the abnormality and the symptoms, but can include both medical and surgical interventions.

Tubal Disease

The term tubal disease refers to abnormalities of the fallopian tubes, the uppermost structures attached to the uterus that are required to transport sperm, eggs and embryos. They are particularly fragile structures and are easily damaged by infection and previous surgery. It is important to remember that tubes must not only be open to be fertile, but that they must have normal function as well.

We can perform tests to determine if tubes are open, and we are capable of re-opening tubes after they have been closed, either surgically or from disease. However, we are not yet capable of repairing the fine structures inside the tubes that provide function. Thankfully we can bypass the need for normal function, and still achieve normal pregnancies inside the uterus, with in vitro fertilization.