Update: December 2018
Unfortunately, not all women can get pregnant “easily and
just “without delay and problems. Various gynecological
diseases stand in the way of motherhood, and in such
Cases medicine comes to the rescue. Laparoscopic surgery
which can be conducted as over the impossibility
get pregnant and because of the treatment of any gynecological
pathology, is one of the methods to help become a mom. But with
the other side in patients who have undergone this manipulation,
a lot of questions arise: when can you get pregnant, for what
need, whether the operation will cause infertility and others.
Laparoscopy: what is the point
Laparoscopy, which in Greek means “I look
the womb “is called the modern surgical method, the essence of which
is to conduct surgery through
small holes (up to 1.5 cm) in the amount of three. Via
laparoscopy operates the organs of the abdominal and pelvic region.
Laparoscopy is widely used in gynecology, as it allows
reach both appendages (tubes and ovaries), and the uterus.
The main laparoscopic instrument is the laparoscope,
which is equipped with a backlight and a video camera (everything that happens in a small
the pelvis is displayed on the television screen). Through 2 other holes are inserted
various laparoscopic instruments. To provide
operative space the abdominal cavity is filled with carbon dioxide
gas. As a result, the belly swells, and the anterior abdominal
the wall rises above the internal organs, forming a dome.
Advantages and disadvantages of the method
First of all it is worth noting that with laparoscopic
access, the surgeon sees significantly wider and more precise organs on which
operates due to multiple optical zoom
areas. Of the other advantages should be noted:
- low invasiveness of organs (they are not in contact with
gloves, air and gauze pads);
- slight blood loss;
- short time in hospital (no more than two – three
- there is practically no pain (except for a feeling of discomfort
abdomen in the first – the second day after surgery until it is absorbed
- the absence of coarse scars, except for the sites of hole closure;
- fast rehabilitation period (does not require bed rest)
- low probability of formation of postoperative adhesions;
- possibility of simultaneous diagnosis and conduct
Of the disadvantages of laparoscopy should be noted:
- requires general anesthesia, which is fraught with various
- requires specially trained surgeons;
- inability to perform some laparoscopic operations
by (large tumor sizes, closure operations
Before performing laparoscopy, as before any other
surgery, you must undergo a certain
The survey, which includes:
- examination of the patient on the gynecological chair;
- complete blood count (with platelets and white blood cell formula);
- general urine analysis;
- blood test for clotting;
- blood chemistry;
- blood per group and Rh factor;
- blood for hepatitis, syphilis and HIV infection;
- gynecological smears (from the vagina, cervix and
- ultrasound examination of the pelvic organs;
- fluorography and electrocardiography;
- husband’s spermogram in case of laparoscopy about
Laparoscopic surgery is assigned to the first phase of the cycle,
immediately after the completion of menstruation (approximately on days 6–7).
Laparoscopy is performed both as planned and as emergency.
indications. Indications for immediate laparoscopic surgery
- ectopic (ectopic) pregnancy;
- ovarian cyst rupture;
- torsion of the legs of an ovarian cyst;
- necrosis of the myoma node or torsion of the subserous myoma node
- acute purulent inflammatory diseases of the appendages
(tubo-ovarian, pyovar, piosalpinx)
But, as a rule, laparoscopic operations are performed in
planned order (not all clinics are equipped with special
equipment). The indications for them are:
- ligation of the fallopian tubes as a method of contraception;
- temporary sterilization (clamping the fallopian tubes
- various ovarian tumors and tumors
- polycystic ovaries;
- genital endometriosis (adenomyosis and endometriosis
- uterine myoma (multiple nodes for myomectomy,
removal of subserous knots on the stem, amputation of the uterus, provided
- tubal infertility, intersection of adhesions in the pelvis;
- abnormalities of the internal genital organs;
- removal of the ovary / ovary or removal of the uterus (amputation and
- restoration of patency of the fallopian tubes;
- chronic pelvic pain of unknown etiology;
- diagnosis of secondary amenorrhea.
Laparoscopic surgery как и лапаротомическая, имеет ряд
contraindications. Absolute contraindications are:
- diseases cardiovascular system in stage
- cerebral hemorrhage;
- coagulopathy (hemophilia);
- kidney and liver failure;
- злокачественные diseases органов малого таза больше 2
degree plus metastasis;
- shock and coma of any etiology.
In addition, laparoscopic surgery is prohibited by
�”Their” specific reasons:
- incomplete and inadequate examination of spouses in the presence of
- presence of genital and general acute and chronic infectious
diseases or in case of recovery less than 6 weeks
- subacute or chronic salpingo-oophoritis (surgical treatment
performed only with acute purulent inflammation of the appendages);
- pathological indices of laboratory and additional methods
- 3 – 4 degree of purity of a vaginal smear;
Laparoscopy: when to get pregnant
And here, finally, came the climax of the article: and when
you can plan a pregnancy or even “aktivnichat” after
performing laparoscopic surgery? Unequivocally answer
This question is not easy, because much depends not only on
the diagnosis about which the operation was performed, but also from
concomitant gynecological diseases, any difficulties
during surgery and in the postoperative period, the age of the woman and
the presence / absence of ovulation before surgery.
After obstruction of the tube (tubo-peritoneal
If laparoscopic surgery was performed on
obstruction of the fallopian tubes (dissection of adhesions), then doctors like
правило, разрешают планировать беременность не ранее, чем
через 3 месяца.
What explains this? After laparoscopy of the fallopian tubes and
the dissection of adhesions, their dragging, the pipes themselves for some time
are in a state of edema, and in order to bounce back, they
need some time. The edema subsides in about a month, but
rest is required and the body will recover after surgery,
«отрегулировать» работу ovary.
There is no doubt that the less time passed after the separation of adhesions,
the higher the chances of conception, but. Against the background of swollen, hyperemic and
being “in shock” pipes are highly likely ectopic
pregnancy, precisely because doctors and recommend to wait. And to
the expectation was not painful, for a three-month period are assigned
combined oral contraceptives, usually monophasic.
This appointment of hormonal pills is not only the goal
to warn “not in time the coming pregnancy”, but also to give
ovaries rest, which after the abolition of pills will start working
(ovulate) in enhanced mode.
After removing the cyst
After laparoscopy for ovarian cysts with pregnancy also
should not rush. Laparoscopic removal of ovarian cyst
very carefully, only the ovarian cyst itself is expelled,
and healthy tissues remain.
Restored ovarian function in most cases already
in a month. And yet, doctors advise to postpone the desired
беременностью как минимум 3, а лучше 6
Oral monophasis is usually prescribed for this period.
contraceptives that protect against unplanned conception,
provide an opportunity to rest the ovaries and normalize hormones.
If the pregnancy occurred earlier than the specified period, then
there may be problems with its course, so do not delay with
visiting the doctor and registration.
Polycystic ovary is characterized by the presence of many small
кист на поверхности ovary. It is possible to conduct the operation in three
- cautery – when an ovarian capsule is produced
- wedge resection – excision of part of the ovary along with
- decortication – removal of a part of a compacted capsule
After such operations with polycystic ability to conceive
(ovulation) is restored for a short period (maximum year).
Therefore, pregnancy planning should begin as early as possible.
(примерно через месяц после операции, когда
sexual rest is canceled).
After ectopic pregnancy
After laparoscopy about ectopic pregnancy, doctors
categorically prohibit getting pregnant for
полугода (не важно, была произведена тубэктомия или
husking of the ovum from the tube with its preservation). This period
necessary to restore hormonal after interrupted
pregnancy (the same as after a miscarriage). Within 6 months
следует предохраняться, принимая hormonal pills.
Laparoscopy of endometriosis is either to remove
endometrial cysts, or cauterization of endometrial foci on
surfaces of organs and peritoneum with simultaneous dissection of adhesions.
Pregnancy has a beneficial effect on the course of endometriosis, since
inhibits the growth of foci and the formation of new ones. But in any
случае, планировать беременность врачи рекомендуют не ранее
чем через 3 месяца.
As a rule, laparoscopic surgery is complemented by the appointment
hormone therapy, which can last for six months. AT
In this case, pregnancy is allowed to plan after graduation
course of hormone therapy.
After uterine fibroids
If laparoscopic conservative myomectomy was performed
(i.e., removal of myoma nodes with preservation of the uterus), uterus
it takes time to form “good” wealthy scars.
In addition, the ovaries also need to “rest” to further
to function effectively. Therefore, pregnancy planning
разрешается не ранее, чем через 6 – 8 месяцев
after operation. AT этот «период покоя» рекомендуется прием оральных
contraceptives and regular ultrasound examination of the uterus (on
the subject of the healing process and scarring consistency).
Pregnancy that occurred before the agreed period may
cause rupture of the uterus along the scar, which is fraught with its removal.
Laparoscopy: the chances of pregnancy
ATероятность беременности в течение года после перенесенной
laparoscopic surgery is present in 85% of women. Pregnancy after
laparoscopy after how much time is possible (by months):
- after 1 month, a positive pregnancy test notes 20%
- within 3 – 5 months after surgery 20% become pregnant
- during 6 to 8 months the fact of pregnancy is registered in
- By the end of the year, the desired pregnancy occurred in 15% of women.
However, 15% of women remain after laparoscopy,
in which pregnancy never occurs. AT подобных ситуациях
Doctors recommend not to delay waiting, but to resort to help.
ECO. ATедь чем дольше времени прошло после операции, тем меньше
become chances to conceive a child.
Rehabilitation after laparoscopy
After laparoscopy, rehabilitation of the body
occurs much faster than after laparotomy (abdominal incision
walls). By evening, the woman is allowed to get up and walk, and
discharge is carried out in a couple – three days. Start eating
also allowed on the day of surgery, but food should be fractional and
Stitches, if they were applied, are removed for 7-8 days. ATыраженных
pain, as a rule, no, but in the first days may
bother with abdominal pain due to abdominal
gas cavity. After its absorption, the pain disappears.
For 2 to 3 weeks, it is recommended to limit recovery.
weights (no more than 3 kg) and physical activity, and sexual rest
should be observed for about a month.
Menstrual cycle after laparoscopy
After undergoing laparoscopic surgery in most
menstruation cases come in time, which is indicated
о нормальном функционировании ovary. Immediately after surgery
moderate mucous or bloody discharge may occur,
what is considered normal, especially if the intervention was done
on the ovaries.
ATозможно продолжение кровянистых незначительных выделений в
for three weeks with the transition to menstruation. Sometimes celebrated
delay of menstruation from 2 – 3 days to 2 – 3 weeks. With more
prolonged delay should consult a doctor.
Monthly after ectopic pregnancy, which was removed
laparoscopy, occur on average in a month, plus – minus
several days. AT первые дни после лапароскопического удаления
ectopic pregnancy appear minor or moderate
spotting, which is absolutely normal. These selections
associated with the rejection of the decidual membrane (where should
embryo attached but not attached) from the uterus.
Getting ready for pregnancy after laparoscopy
In order to increase the chances of conceiving and reduce the risk
possible complications of the desired pregnancy that occurred, first
queue must be examined:
- compulsory visits to the gynecologist;
- general clinical tests (blood, urine), according to indications biochemistry and
- PCR analyzes for genital infections (if detected
- smears from the vagina, cervix and urethra;
- determination of the hormonal status (if indicated) and correction
- Ultrasound of the reproductive system;
- Genetics consultation (preferably for all couples).
ATозможно, что понадобится и более расширенное обследование,
for example, colposcopy or breast ultrasound, which
decides the doctor observing the woman.
AT период планирования беременности рекомендуется соблюдать ряд
- taking folic acid for at least three months before the planned
- completely give up bad habits, including
- lead a healthy and active lifestyle (walking in the fresh
air, moderate physical and athletic load);
- redefine your diet in favor of healthy and
- avoid stressful situations whenever possible;
- calculate or determine the days of ovulation (by special test
ovulation) and aktivnichat during this period.
How is pregnancy going after laparoscopy
Subject to the terms after which the pregnancy
allowed, and recommendations during the planning period, pregnancy,
As a rule, proceeds without complications. ATсе отклонения от
the normal course of the gestation period are not related to
performed laparoscopic surgery, and with a reason about
which operation was done.
For example, when pregnancy occurs after laparoscopy
ovaries earlier than 3 months, the risk of threat increases
interruptions in the early stages due to the failure of the hormone function
ovary. Therefore, in this situation, the doctor is likely to prescribe
progesterone and antispasmodic drugs for the prevention of miscarriage. Not
development of other complications of gestation is excluded:
- intrauterine infection due to chronic inflammatory
- polyhydramnios (as a consequence of infection);
- Placenta previa (after removal of myoma nodes);
- placental insufficiency (hormonal dysfunction,
- incorrect position and presentation of the fetus (surgery on
Transferred laparoscopic surgery is not an indication.
for carrying out planned caesarean section therefore childbirth conduct through
natural birth canal. The only exceptions are those
operations performed on the uterus (removal of myoma nodes or
uterine reconstruction regarding developmental abnormalities), since after them
scars remain on the uterus, creating the danger of its rupture during
childbirth. Complications of childbirth that are possible are related to the presence of
gynecological pathology, which was held
laparoscopy, not with surgery:
- anomalies of generic forces;
- prolonged labor;
- early postpartum hemorrhage;
- postpartum subinvolution of the uterus.
ATопрос: Полгода назад мне сделали лапароскопию, а
the pregnancy did not come, it means that the operation was
Ответ: Лапароскопическая операция не может быть
ineffective. In any case, for whatever reason
was performed (polycystic ovary, cyst or ectopic), surgeon
eliminated all pathological formations. Half a year is definitely a term
already decent, but pregnancy can occur after 9, and after
12 months. The main thing is to follow the recommendations of the doctor.
ATопрос: Почему после лапароскопической операции
Ответ: ATо-первых, следует уточнить, в течение
how long after surgery, pregnancy does not occur. If passed
less than a year, then you should not worry
undergo ultrasound of the pelvic organs and pass blood tests for hormones
(progesterone, estrogen, prolactin, testosterone). In some
cases, the doctor prescribes and more detailed examination to clarify
causes of infertility. It is possible that the operation was performed on
pipe obstruction and patency has been restored, but has
the place is also anovulation or any pathology in the husband’s sperm.
ATопрос: Мне после лапароскопии врач назначил
hormonal pills. Do I have to take them?
Ответ: Да, после лапароскопической операции, не
it is important for what it was carried out, hormonal pills
take necessarily. They not only protect against unwanted
While pregnancy, but also normalize hormones and give rest