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Advanced Reproductive Surgical Procedures

As the only level 1 (general anesthesia) fertility facility in B.C., we are able to provide a variety of advanced reproductive surgical procedures, including tubal ligation reversal, vasectomy reversal, microsurgical testicular sperm extraction (microTESE), and operative hysteroscopy. On occasion patients with challenging anatomy or lower pain thresholds require general anesthesia for egg retrieval. This level of surgical care also allows us to perform emergency procedures like dilatation and curettage (D&C) on an emergency basis. This combined with our physician call group and on-site OBGYN ultrasound services allows rapid delivery of MSP insured gynecologic services for patients under our care.

Surgery is often a weighted word that brings with it fear and anxiety. PCRM’s Physicians are well-trained experts in minimally invasive surgery, specializing in mini-incision techniques to make surgery as unobtrusive as possible.

Our minimally invasive surgeries provide solutions for fertility, endometriosis, uterine fibroids, heavy periods, and reproductive solutions such as vasectomy and tubal ligation reversal.

Close up of surgical procedure at PCRM
A fertility specialist performs fertility research with a microscope | PCRM Fertility Clinic Vancouver

Micro-TESE

Microsurgical Sperm Retrieval (Micro-TESE) – Standard of Care for Non-Obstructive Azoospermia Male factor infertility is...

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Microsurgical Sperm Retrieval (Micro-TESE) – Standard of Care for Non-Obstructive Azoospermia

Male factor infertility is present in more than half of couples with delayed conception, making it the leading cause of subfertility in North America. Between 5 and 10% of these men have a complete lack of sperm due to reduced production (non-obstructive azoospermia). Testicular biopsy reveals that these men have Sertoli cell-only pattern, maturation arrest, or hypospermatogenesis. Until recently, these men with primary testicular failure were considered “sterile”, and donor sperm insemination or adoption recommended as the only means of having a family. Several observations have changed the approach to this condition. Direct evaluation of testis biopsy specimens often demonstrates sperm in men with non-obstructive azoospermia, but not at high enough levels to yield sperm in the ejaculate. It was previously assumed that sperm must traverse the male reproductive tract before acquiring the ability to fertilize an egg. These sperm do have severely impaired motility and function, and are ineffective when used for intrauterine insemination (IUI) or standard in vitro fertilization (IVF) culture. Using the procedure called intracytoplasmic sperm injection (ICSI), eggs can now be fertilized with these sperm by physically injecting them into the cytoplasm of the egg (ooplasm). ICSI was first performed in 1990 and has virtually cured male factor infertility world-wide. The vast majority of infertile men can eventually father a child using this technique.

With advances in sperm retrieval techniques, sperm can be found in nearly half of men with non-obstructive azoospermia. Microsurgical testicular sperm extraction (Micro-TESE) is a procedure that allows for the precise removal of tiny volumes of testicular tissue is areas of active sperm production using a microscope, improving sperm yield compared to traditional biopsy techniques. Seminiferous tubules (structures where sperm is produced and transported) containing sperm can often be identified under an operating microscope after opening the testis. This approach has a number of advantages over other sperm retrieval techniques. It maximizes the yield of spermatozoa while minimizing the amount of testicular tissue required and vascular injury created, by making identification blood vessels easier. Sperm harvested from these patients is very difficult to cryopreserve due to a combination of the limited numbers and quality, so optimal pregnancy rates are achieved using the sperm fresh.

Using fresh sperm requires synchronizing the Micro-TESE procedure with retrieval of the female partner’s eggs. The medical team at The New York Presbyterian Hospital-Weill Medical College of Cornell University, under the direction Dr. Peter Schlegel pioneered the technique and is the major referral centre in the U.S. for difficult azoospermia cases. In 2007, Dr. Schlegel performed the first Micro-TESE procedure at PCRM as a visiting professor. With a fully functional operating theatre on-site, and embryologists with years of TESE experience in an adjoining full-equipped IVF laboratory, PCRM has proven to be well suited for Micro-TESE. Since that day we have provided a consistent volume of Micro-TESE for these severe cases with a cumulative pregnancy rate of 78%.

We are the only centre in Canada capable of fresh Micro-TESE; this urological procedure is done through our Sub-specialty urology staff, Drs. Victor Chow, and Kenneth Poon. Many centres perform this outside the clinic, and freeze sperm, however, the ability to procure fresh sperm is highly linked to better pregnancy outcomes. Many other fertility centres in Canada refer patients to PCRM for this procedure.

Tubal Ligation Reversal

Tubal ligation reversal is a safe and effective procedure which involves reconnecting a woman’s fallopian tubes once they have been "tied" (tubal ligation).

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Tubal ligation reversal is a safe and effective procedure which involves reconnecting a woman’s fallopian tubes once they have been “tied” (tubal ligation). Although tubal ligation is often thought of as a permanent, irreversible form of contraception, tubal ligation reversal is an outpatient surgical procedure allowing the possibility of pregnancy.

Approximately 6% of women will request information about tubal ligation reversal within 5 years of tubal ligation. While there are other methods of fertility treatments (such as In Vitro Fertilization, or IVF) that offer similar success rates, some benefits of tubal ligation reversal may make this method a more attractive option. Some of these perceived and actual benefits are:

  • Natural conception
  • Lower risk of multiple pregnancy
  • Lower cost

Various methods can be used to perform a tubal ligation. The chances of achieving a pregnancy following a tubal reversal depend on the method used to “tie” the tubes.

Some of the many methods of tubal ligation include:

  • Ring or clip to occlude the tube
  • Removal of some of the fallopian tube
  • Cautery/burning a portion of the tube

Of the methods listed, application of a ring or clip to the tube offers the best outcome following tubal reversal as it involves the least amount of tubal damage.

Removal of a portion of the fallopian tube is commonly performed in conjunction with a Cesarean section. Cautery of a portion of the fallopian tube is often performed as a laparoscopic procedure. These types of ligation are generally amenable to reversal, but are dependent on the length of fallopian tube removed or burned at the time of surgery. An estimate of the length of tube that was removed can be obtained from the pathology report which is created at the time of tubal ligation.

Tubal Ligation Reversal Procedure

The operation is usually performed on an outpatient basis, using a very small (5-8 cm) bikini-type incision. The operation typically takes 2-3 hours. Numbing medicine is injected into the skin after the operation so that the patient is comfortable enough to leave the surgery centre several hours post operatively. Recovery time is shorter because of the small incision size, but your ability to return to normal activities or work will vary.

Pre-procedure Testing

There are a few reports which should be obtained obtain prior to undergoing tubal ligation reversal. While these items are not essential, they are recommended. They are:

Operative report and pathology report of tubal ligation (frequently obtained from the surgeon or hospital where the procedure was performed)
Sperm function testing to rule out other fertility issues (this testing can be performed at PCRM)

A nurse at PCRM Vancouver assists in a fertility treatment | PCRM Fertility Clinic Vancouver

General Anesthesia

General anesthesia is available at PCRM, by hospital anesthesiologists and must be booked in advance.

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PCRM is unique in having a fully functioning operative suite with full compliance through the College of Physicians and Surgeons of British Columbia, under the Non-Hospital Medical Surgical Facilities (NHMSF) credentialing process. We have full capacity to offer general anesthetic. We have a full complement of 12 Anesthetic consultants who offer services when required.

Occasionally, Anesthetic is required for egg retrievals. Also, the provision of surgical services for tubal ligation reversal and vasectomy reversal* is vital.

Due to our provision of these services, we are the only centre in Canada capable of fresh Micro-TESE; this urological procedure is done through our Subspecialty urology staff, Drs. Victor Chow, and Kenneth Poon. Micro-TESE was pioneered through Cornell-Weill Medical College in New York, and is a unique method to obtain sperm in patients with extremely poor fertility prognosis otherwise. Many centres perform this outside the clinic, and freeze sperm, however, the ability to procure fresh sperm is highly linked to better pregnancy outcomes. Many other fertility centres in Canada refer patients to PCRM for this procedure.

Close up of surgical procedure at PCRM's fertility clinic | PCRM Fertility Clinic Vancouver

Hysteroscopy

Small problems like polyps or fibroids are often very treatable with hysteroscopic surgery. This is a day surgical procedure, with minimal recovery times required.

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By placing a small, telescope-like device through the cervix into the uterus, a hysteroscopy enables your physician to see into the uterine cavity with clarity and provides him or her with a means to surgically treat any abnormalities.

Small problems like polyps or fibroids are often treatable with hysteroscopic surgery. This is a day surgical procedure, with minimal recovery times required. The procedure can be performed at PCRM (currently only available at our Burnaby location) or by a gynecologist at a hospital. At PCRM, the procedure is performed while the patient is awake, using some oral medications for gentle sedation and freezing around the cervix.

What type of fertility problems can be treated by hysteroscopy?

Hysteroscopy typically treats abnormalities of the uterine cavity. This could be fibroids, polyps, or adhesions (scar tissue) within the uterus.

Is this procedure painful?

Typically the hysteroscopy procedure is quiet tolerable while awake. It is usually performed with some oral medication for relaxation and local anesthesia (cervical block) freezing. The patient can return home the same day, and return to normal activities the following day. Some bleeding and/or spotting can be expected for up to a week.