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JIVA Fertility

Reproductive and Gynaecology Surgery

Expert Surgical Care for Gynaecology Conditions affecting Fertility

At JIVA Fertility, we appreciate that some fertility challenges and gynaecology conditions require surgical treatment:
- to reduce your symptoms
- in some situations to improve natural fertility
- prior to assisted conception treatment.

Our Consultant, Mr. Harish Bhandari is a confident gynaecology and reproductive surgeon who is able to offer laparoscopic, hysteroscopic, and open surgeries, as appropriate, to treat various gynaecology conditions affecting fertility.

Endometriosis

Endometriosis is a common condition where tissue similar to lining of the womb (endometrium) grows outside the womb, and can cause various symptoms and infertility via pelvic inflammation, anatomical distortion, pelvic adhesions and tubal damage/blockage.

How will surgery help women with endometriosis associated infertility?
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1. Diagnostic laparoscopy and dye test will help assess your pelvis and to check if the fallopian tubes are patent (open) or blocked/damaged. We will perform surgical treatment to Stages 1 and 2 endometriosis and/or mild pelvic adhesions (scarring inside the pelvis) at the same time to improve the chances of natural conception.
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2. We offer laparoscopic surgery for severe forms of endometriosis in certain circumstances:
- for removal of endometrioma (ovarian cysts from endometriosis) if causing symptoms or expected to cause difficulty with fertility treatment or in pregnancy
- for removal or apply clips to damaged fallopian tubes with fluid (hydrosalpinx) before IVF/ICSI treatment, as the fluid reduces your chances of pregnancy.
- for management of your symptoms, you will need a referral via GP to the nearest Advanced Endometriosis Centre.

Uterine Fibroids

Uterine fibroids are common, non-cancerous growths from the muscle wall of the womb (uterus) that can cause symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms and also difficulty conceiving/infertility.

We provide appropriate information about various surgical treatment options for fibroids which depends on the location, number and size of fibroids and your circumstances using either Hysteroscopic resection of submucous fibroids or Open Myomectomy (fibroid removal by making a cut in your abdomen). You may sometimes need both procedures at three months interval. We recommend not to conceive for 3-6 months after these procedures.

‍1. If you have symptomatic fibroids, and non-hormonal medical treatment is not helping your symptoms while trying to conceive.
2. If you have fibroids distorting womb cavity (either submucous fibroids or intramural fibroids with a submucous component).
3. For large fibroids (typically over 6 cm) distorting pelvic anatomy - prior to conceiving to reduce the risks in pregnancy.
4. If you have sadly experienced recurrent pregnancy loss or failed IVF cycles, we will discuss personalised treatment for fibroids.

Ovarian Cysts

Ovarian cysts (fluid filled sacs, three cm or more in diameter) are common in women before menopause and can cause pelvic pain and other symptoms, and occasionally, causing difficulties with fertility treatment. A vast majority of ovarian cysts are benign. You will need more investigations such as blood tests and MRI scan for further assessment and a referral to Gynaecology Oncologists for management if there is any suspicion of cancer.

Do all ovarian cysts need to be removed before conceiving?
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1. Not all types of ovarian cysts need to be removed before conceiving or prior to fertility treatment - we will be able to guide you to make an informed decision.
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2. We advise Laparoscopic removal of ovarian cysts:
- to help with your symptoms
- for an accurate diagnosis
- when they are causing or expected to cause potential difficulties during fertility treatment or in pregnancy.

3. There may be some circumstances where the whole ovary may need to be removed

4. We generally do not recommend just removing just the fluid from ovarian cysts (cyst aspiration) as the cysts are likely to fill up again. However, this can be considered in some circumstances.

Fallopian tubes blockage or disease

The fallopian tubes are attached to the top of the uterus (womb) on both sides. Blockage or damage to fallopian tubes is a common reason for infertility (one in five couples). Blockage could be either in the end close to the womb (proximal blockage) or in the free end in the pelvis (distal blockage) or anywhere within the tube. Blockage can sometimes cause fluid secretion to accumulate within the fallopian tube (hydrosalpinx) and this fluid has been shown to affect embryo implantation and reduce IVF/ICSI treatment success.

Will are the different surgeries for damaged fallopian tubes?
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1. If you have hydrosalpinx, we recommend Laparoscopic removal of damaged fallopian tube/s prior to IVF/ICSI treatment.
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2. If you have distal blockage/hydrosalpinx, and you do not wish for the fallopian tubes to be removed, Laparoscopic Fimbrioplasty or Cuff salpingostomy are alternatives, the success of which depends on the extent of damage. There will be no guarantee that the tube will function normally after this procedure for a natural pregnancy and that the hydrosalpinx will not return at a later date. A Hysteroscopy procedure will be undertaken at the same time to release adhesions around the opening of the fallopian tubes, if present.
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3. Laparoscopy guided Hysteroscopic proximal tubal catheterisation is an operation performed for proximal tubal blockage - Mr. Harish Bhandari can perform this procedure for selected patients through his NHS practice - you will need to be referred from your GP to his NHS Gynaecology Clinic.

Endometrial Polyps

Endometrial polyp is an abnormal growth from the endometrium (lining of the womb) that can cause abnormal bleeding and can affect embryo implantation and fertility. Endometrial polyps can occasionally be pre-cancerous or due to cancer.
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How is an endometrial polyp removed?
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Hysteroscopy and endometrial polypectomy is a minor surgical procedure to remove endometrial polyps – either to reduce your symptoms or in certain circumstances to improve fertility or prior to fertility treatment.

Intra-uterine adhesions (IUA)

IUA is scarring inside the womb cavity caused mostly by damage to endometrium (lining of the womb). In most cases this is either due to a previous operations on the uterus (womb) or from infection inside the uterus. IUA can cause symptoms such as light or absent menstrual periods, cyclical lower abdominal pain, and can be associated with or cause infertility or miscarriage.

Thin endometrium identified on ultrasound scan, may be a sign of IUA or damage to endometrium.

Do I need an operation for treatment of IUA?
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We advise Hysteroscopy for womb cavity assessment and perform intra-uterine adhesiolysis (release or divide scarring) inside the womb cavity, which in some circumstances, will improve symptoms, fertility and further pregnancy outcome. Various interventions will be used to minimise the risk of further IUAs.

Congenital uterine anomalies (CUA)

CUAs are malformations of the uterus (womb) that develop during fetal life. Some women with CUAs often do not have any symptoms, but may experience painful periods. CUAs are often discovered during investigations for infertility or miscarriage. Depending on the type and severity of CUAs, there may be increased risk of miscarriage and pregnancy complications. 3D ultrasound scan of the uterus can identify some of these CUAs, and in some cases, MRI scan or an operation will be required to make a diagnosis.

Do I need surgery for correction of CUA?

1. If you have suffered recurrent miscarriages or recurrent failed IVF treatments, we advise Hysteroscopic surgery for Uterine Septum, a type of CUA where the womb cavity is divided by a muscular or fibrous partition.

2. Surgical treatment for other types of CUAs is not usually recommended

What happens at your appointment?

Once you have requested or booked an appointment, one of our team members will contact you to check the possible reasons for your appointment. We send you a patient introduction pack including information about various charges.

If you have chosen one of our Fertility or Recurrent Miscarriage Assessment package, you will be advised to attend for the tests as highlighted in the Package, before your appointment.

You will have 40 to 75 minutes appointment (depending on the type of appointment) which will include the following:

1. A detailed review of your medical history
2. We will perform a detailed ultrasound scan of the pelvis (additional fees will apply unless this is included in your chosen Assessment Package) for:
  - 3D assessment of the uterus
  - Endometrium (lining of the womb)
  - Presence of congenital or acquired uterine pathologies such as fibroids, adenomyosis, uterine septum etc.
  - Detection of Hydrosalpinx
  - Ovarian cysts
  - Assess antral follicle count
3. You will be advised of further tests and/or treatment options, based on available information. If further tests are required, you need to arrange a follow up appointment once they are complete.

At JIVA Fertility, we combine surgical expertise with a patient-centered approach, ensuring you receive the best possible care and support.

Come & Visit Us

New York, NY 10001

123 Main Street

Apt 4B

Contact: +123 456-7890

Los Angeles, CA 90012

456 Elm Avenue

Suite 300

Contact: +122 555-1212

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