Reproductive Surgery

Reproductive Surgery

Expert Surgical Care for Fertility & Gynaecological Conditions: At JIVA Fertility, we understand that some fertility challenges and gynaecological conditions require surgical treatment to improve natural conception or the success of assisted reproductive treatments like IVF. Our expert reproductive surgeon, Mr. Harish Bhandari, specializes in advanced laparoscopic, hysteroscopic, and open surgeries to treat conditions that affect fertility, helping you move forward with confidence.

Endometriosis and its impact on fertility: Endometriosis is a common condition where tissue similar to the lining of the womb (endometrium) grows outside the womb, causing various symptoms and contributing to infertility via pelvic inflammation, anatomical distortion with pelvic adhesions and tubal blockage.

How will surgery help in women with suspected endometriosis:

• Diagnostic laparoscopy and dye test is required for assessment of infertility in women who have symptoms of endometriosis and or have risk factors for pelvic pathology affecting fertility. Excision/diathermy to minimal mild endometriosis if identified, will be undertaken at the same time as it will improve the chances of natural conception. 
• Surgery for severe forms of endometriosis is advised for the management of your symptoms; for damaged and blocked fallopian tubes (hydrosalpinx); for some ovarian cysts due to endometriosis (endometrioma).
• Laparoscopy to remove endometriomas (ovarian cysts related to endometriosis) will be required to improve pain symptoms and in some circumstances before IVF/ICSI treatment.
• Laparoscopic removal of damaged and blocked fallopian tube/s (hydrosalpinx) will be required before IVF/ICSI treatment. 
  

Uterine Fibroids: Uterine fibroids are common, non-cancerous growths from the muscle wall of the womb that can cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms and can cause difficulty conceiving/infertility. We can guide you with appropriate treatment options for fibroids if you wish to keep your fertility options open or planning your fertility treatment or if you have had early pregnancy losses or failed IVF/ICSI treatment cycles.

When is surgery for fibroids recommended:

• For fibroids distorting the womb cavity (submucosal fibroids or intramural fibroids with a submucosal component) – Open myomectomy (fibroid removal by making a cut in your abdomen) or hysteroscopic resection may increase pregnancy success.
• For large fibroids (typically over 6 cm) – If they distort pelvic anatomy, surgical removal may be beneficial.
• If fibroids are causing recurrent pregnancy loss or failed IVF cycles – A personalised treatment plan will be discussed.
  

Ovarian Cysts: Ovarian cysts are common in women before the menopause. They are generally larger fluid filled sacs (three cm in diameter or more) on or in the ovary, that can cause pelvic pain and other symptoms including difficulty becoming pregnant, depending on the nature and size of the cysts. The vast majority of these identified cysts are benign. You will need blood tests if the cysts appear complex on the ultrasound or MRI scan

• Not all types of ovarian cysts need to be removed before conceiving or prior to fertility treatment, and we will be able to guide you to make an informed decision.
• Laparoscopic removal of ovarian cysts will be required to help with symptoms or where an accurate diagnosis need to be made
• There are some circumstances where the whole ovary may need to be removed
• Removing fluid from a simple cyst (aspiration) is not the best option as the cyst is likely to fill up again, but can be done in some circumstances to help to determine what type of cyst it is or just before fertility treatment if the hormones from the cyst are affecting treatment cycle.
  

Fallopian tubes blockage or disease: The fallopian tubes are attached to the uterus (womb) on both sides. Blockage or damage to fallopian tubes is a common reason for infertility. Blockage could be either in the attached end to the womb (proximal blockage) or in the free end in the pelvis (distal blockage) or anywhere in the tube. Damage and blockage of the free end portion of a fallopian tube can make it swollen and fluid-filled (hydrosalpinx) which may reduce IVF/ICSI treatment success.

• Laparoscopic removal of hydrosalpinx (fluid filled tubes) – This improves IVF success rates.
• Hysteroscopic tubal catheterisation – Helps clear proximal tubal blockages (near the uterus) in select cases.
• Laparoscopic salpingostomy or adhesiolysis – May help distal tubal blockages (near the ovaries), depending on the extent of damage. Hysteroscopy procedure can be undertaken at the same time to release adhesions (scarring) around the opening of the fallopian tubes.
  

Endometrial Polyps: Endometrial polyps are the growths from the endometrium (lining of the womb) that can cause abnormal bleeding and may affect fertility, both natural and following assisted conception. Endometrial polyps can occasionally be pre-cancerous or due to cancer

• Hysteroscopy and endometrial polypectomy is a minor surgical procedure to remove endometrial polyps if they are causing symptoms or in certain circumstances to improve fertility or prior to fertility treatment, especially if they are one cm or more in size.
  

Intra-uterine adhesions (IUAs): IUAs are caused by damage to the endometrium (lining of the womb) and in most cases due to previous operations on the uterus (womb) or severe infection of the uterus. IUAs can cause symptoms like lighter or absent menstrual periods, infertility, cyclical lower abdominal pain, or recurrent miscarriage. During Fertility assessment/treatment, the endometrium is thin for the stage of your menstrual/treatment cycle.

• Hysteroscopic intra-uterine adhesiolysis is a surgical procedure to divide the scar tissue inside the womb cavity. In some circumstances, this may help improve fertility. Various interventions will be used to minimise the risk of further IUAs.
  

What happens at your first appointment?

After making an appointment to be seen in the JIVA Fertility Gynaecology or Fertility or Recurrent Miscarriage clinic, one of the members of the team will contact you to check the possible reasons for your appointment and you will be sent a patient introduction pack including information about various charges

You will have 40 to 60 minutes appointment (depending on the type of the clinic) with Mr Harish Bhandari which will include the following:

• A detailed and comprehensive review of your medical history including the details of previous miscarriages
• A detailed ultrasound scan of the pelvis (as appropriate) including:
  
  • 3D assessment of the uterus 
  • Endometrium (lining of the womb)
  • Presence of congenital or acquired uterine pathologies such as fibroids, adenomyosis, uterine septum etc. 
  • Evidence of damaged tubes (hydrosalpinx)
  • Pelvic pathologies such as ovarian cysts 
• You will be advised on further investigations and/or treatment based on your clinical history, test results and the ultrasound scan findings. In some instances, we would then suggest you return for a follow up appointment to review the results before agreeing a final treatment plan

At JIVA Fertility, we combine surgical expertise with a patient-centered approach, ensuring you receive the best possible care to support your fertility journey. If you have been struggling to conceive or experienced recurrent miscarriages, or need surgical intervention before IVF, we are here to help.‍