**6. Endoscopy complications**

18 Enhancing Success of Assisted Reproduction

**5. Differential diagnosis** 





**5.1. Complications:** 

**5.2. Therapy** 

pain as the result of adhesions.

laparoscopy to be in use.

**Adnexal torsion** 

Tubo-ovarian abscess is an advanced form of pelvic inflammatory disease most often caused by spread of bacteria from the lower genital tract. It is one of the most severe complications of PID and can lead to significant morbidity and occasional mortality. The microbial etiology of TOAs typically is polymicrobial with a mixture of anaerobic, aerobic, and facultative organisms being isolated. The most common bacterial pathogens are anaerobic. Sexually transmitted disease, early age of first sexual encounter, multiple sexual partners, douching, IUDs are at increased risk for pelvic inflammatory disease and tubo-ovarian

Infertility due to tubal occlusion, increased risk of ectopic pregnancy, and chronic pelvic

Treatment of TOA historically was surgical with most women having a total abdominal hysterectomy and bilateral salpingo-oophorectomy Management of TOAs has changed drastically in the past decades with the advent of broad-spectrum antibiotics (ampicillin, clindamycin, and flagyl) and continues to evolve with improved imaging and drainage techniques. Recently antibiotics, surgical intervention, with either conventional surgery or

Adnexal torsion is an uncommon gynecologic emergency that is caused by the twisting of the ovary, fallopian tube, or both along the vascular pedicle. It is a rare gynecologic emergency of women at reproductive ages. Usually adnexal torsion is a process of benign tumors. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. The causes of adnexal torsion include functional and pathologic ovarian cysts, paraovarian cysts, ovarian hyper stimulation, adhesions, ectopic pregnancy, and congenital malformations. Classically,

abscess. Diverticulitis and appendicitis are also potential causes.


**Tubo ovarian abscess** 

Diagnostic laparoscopy is normally the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment. For the most part, the risks associated with laparoscopy are of the same type that occurs with traditional surgery. Problems from anesthesia, bleeding and infections can occur with either type of surgery. The risk of damage to internal organs is also possible with either type of surgery. The risks of laparoscopy are minimal. Complications among young, healthy women undergoing laparoscopy are rare and occur only in about three out of 1000 cases. These complications can include injuries to structures in the abdomen such as: injury to the bowel, stomach, urinary bladder, ureters, abdominal and pelvic blood vessels, ovaries and uterus. For such injuries, a laparotomy might be necessary to stop bleeding or make repairs. Most often, these injuries occur when the laparoscope is placed through the navel. The risk of a serious complication is less than 1%. Any surgery can have an anesthesia-related complication or be associated with post-operative infection, Fortunately, all of these complications are very unusual. According to the American Society of Reproductive Medicine, one or two women out of every 100 may develop a complication, usually a minor one. Some common complications include:

	- Gas Embolism
	- Blood clots
	- Hernia
	- Thermal Injury
	- Port site metastasis
	- Other general anesthesia complications
	- Death (around 3 in every 100,000)

Certain conditions make laparoscopic surgery a bad choice. Some of these conditions include:

The Role of Endoscopy in Management of Infertility 21






**7.2. The advantages of hysteroscopy** 




**7.3. Resection of polyps/fibroid** 

In the past, the treatment of benign uterine lesions metrorrhagia; Hysteroscopic surgery is effective to treat menorrhagia and leiomyomas, and other lesions, such as septate uterus and synechiae. In the last 20 years there has been an increased acceptance of hysteroscopic surgery into the gynecological surgery. Diagnostic hysteroscopy is a highly sensitive and specific technique for the management of uterine bleeding problems. It may distinguish between myomas or polyps and provides additional information about surrounding endometrium. Endometrial polyp is the commonest pathology among the structural uterine abnormalities. A polyp is attached to the intestinal wall either by a stalk, peduncles, or by a broad base. The sizes of uterine polyps range from a few millimeters — no larger than a sesame seed — to several centimeters — golf ball sized or larger. Many women with myomata, polyps, uterine septae, and synechiae may now benefit from the convenience of hysteroscopic therapy compared to more aggressive surgical techniques. Hysteroscopy is the first choice in the resection for the treatment of endometrial polyps in women with abnormal uterine bleeding and postmenopausal metrorrhagia. The greatest advantage of hysteroscopic myomectomy is the quick recovery time. The prevalence of malignancy or atypical hyperplasia is 3.2% in women with symptoms and 3.9% in those without symptoms. Transcervical resection is the gold standard for treatment of endometrial polyps.

Intrauterine adhesions develop as a result of intrauterine trauma. Intrauterine adhesions can be asymptomatic and of no clinical significance. Symptoms associated with clinically

Uterine polyps most commonly occur in women in their 40s and 50s.

**7.4. Intrauterine adhesions- adhesiolysis** 

significant intrauterine adhesions include:



As in all aspects of medicine, laparoscopic surgery requires experience on the part of the surgeon in order to afford patients the best possible outcome. Accurate diagnosis and appropriate management of complications are requisite of all surgeons.
