Surgery

Sometimes, anatomical problems in either the man or woman may be the cause of conception difficulties. This is a relatively common problem.

If your healthcare provider suspects this is the case, surgery may be the recommended initial treatment to improve the chances of conception.

In some cases, the healthcare provider may use other medications in conjunction with surgery. Or the healthcare provider may choose to pursue other treatments first, reserving surgery as an option if those treatments aren't successful. Every patient is different, and your healthcare provider's plan of care will be based on your specific diagnosis and history.

Surgical Treatments


Endometriosis

The treatment of endometriosis depends upon its severity. In some cases, the healthcare provider may recommend treatment with medication before attempting surgery.

If the endometriosis and symptoms are more severe, your healthcare provider may recommend surgery to remove the endometriosis. The treatment may involve laparoscopy. In this procedure, a small incision is made in the lower part of the abdomen and a laparoscope — a tiny camera — is used to examine the pelvic cavity. Then, using microsurgery or laser surgery, the endometriosis is removed.

Adhesions

Adhesions are often diagnosed and treated with laparoscopy. The laparoscope is inserted into the pelvic cavity through a tiny incision made just below the woman's navel. Other instruments, such as lasers or electrocautery devices, may also be used to remove the adhesions during the surgical procedure. They, too, are inserted through small incisions.

To diagnose intrauterine adhesions, a healthcare provider may use an x-ray procedure called hysterosalpingography (HSG). A more accurate method for diagnosis, however, is called hysteroscopy. During this procedure, a hysteroscope (a thin telescope-like instrument) is inserted through the cervix so the healthcare professional can see the uterine cavity. Generally, intrauterine adhesions are removed with hysteroscopic guidance using instruments such as a laser, electrocautery device, or scissors.

Fibroids

A healthcare provider may conduct a hysterosonogram to detect if there are any fibroids. During this procedure, the healthcare provider injects a small amount of sterile saline into the uterus by passing a small catheter through the cervix. An ultrasound is then performed. This test is usually done in the healthcare provider's office.

Myomectomy is the name for the surgical procedure in which the fibroid tumor or tumors are removed. Sometimes, a less invasive procedure called laparoscopic myomectomy is possible. It offers a much shorter recovery time.

Uterine Malformation

A septate uterus contains an interior wall that can divide the uterus in two (similar to a chamber in the heart). In some cases, this wall can extend the entire length of the uterine cavity to the cervix. Surgery to remove the wall, or septum, can usually correct this condition. The procedure is performed either with a hysteroscope or with a laparoscope through an abdominal incision.

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Indication:
For women, Gonal-f® (follitropin alfa for injection), Gonal-f® RFF (follitropin alfa injection) and Gonal-f® RFF Pen (follitropin alfa injection) are indicated for 1) the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure and 2) for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
For men, Gonal-f® is also indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the main cause of infertility is not due to primary testicular failure.

Important Safety Information:
These products should only be prescribed by physicians specializing in fertility or reproductive health. Use of Gonal-f® or Gonal-f® RFF by women can result in multiple births. Patients should let their doctor know of any allergic reactions to recombinant FSH preparations or other product ingredients. Patients should also inform their doctor of a history of cancer of the sex organs or brain and uncontrolled thyroid or adrenal disease before starting or continuing treatment. Women with a history of abnormal bleeding from the uterus or vagina, swollen, enlarged, or painful ovaries should speak to their doctor before starting treatment. Gonal-f® and Gonal-f® RFF are potent gonadotropic substances capable severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women, which can result hospitalization. Women should inform their doctor if they experience severe stomach pain, vomiting, bloating, or weight gain while taking Gonal-f® or Gonal-f RFF®. The most common side effects are headache, ovarian cysts, upset stomach, and sinus infections in women taking Gonal-f® or Gonal-f® RFF. The most common side effects in men taking Gonal-f® are skin acne, breast pain and growth, and tiredness. Needle injections may cause some discomfort.

For more information, refer to the prescribing and patient information offered below and talk to your doctor.


© EMD Serono, Inc. CIM Last Update 2008-09-16
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