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If a woman who has had a terminated pregnancy in the past has difficulty conceiving now, this may be due to scarring of the uterus. This condition is often referred to as Asherman’s syndrome or uterine synechiae.
A diagnosis of this syndrome can be confirmed by performing a saline sonogram. In this test, sterile water is infused into the uterine cavity during a vaginal sonogram.
Assisted reproductive technologies like in vitro fertilization would not be effective in these cases. Instead hysteroscopy with lysis of adhesions and possibly a staged procedure may be necessary to reconstruct the uterine cavity.
Twenty percent of couples seeking infertility therapy have polycystic ovarian syndrome. Women with this diagnosis will have clinical signs of irregular periods or months between periods. Women can be treated with medical therapy, such as clomid, metformin and other fertility medications, or a surgical procedure known as ovarian stromal cauterization.
Ovarian stromal cauterization aka “ovarian drilling” is a laparoscopic procedure that works in 90 percent of patients with polycystic ovarian syndrome. This procedure involves making a series of 10 to 15 holes in each ovary through a small hole in the abdomen.
Pelvic pain can be debilitating to women. Severe pelvic pain can affect all aspects of the woman’s life socially, psychologically, emotionally and professionally. If medical therapy fails, surgical management may be necessary.
We have developed a technique known as LUNR a modification of the procedure known as laparoscopic uterine nerve ablation. During this procedure a laparoscopy is performed and the uteral sacral nerves are identified. The uteral-sacral nerve carries the pain fibers from the uterus. One centimeter of the nerve is resected from each side. This surgical procedure has allowed couples to enjoy intimacy who were unable to do so in the past.