Fertiliscopy

with Charles Koh, M.D, reproductive specialist at Columbia St. Mary’s

Last Updated: Nov. 1, 2003

Transvaginal laparoscopy. Since this is a phrase that is not thrown around in common conversation, chances are, you’ve never heard it before. But if women’s health and fertility are topics that interest you, this is a procedure you should become familiar with.

Transvaginal laparoscopy is a procedure that began in Europe and has been gradually gathering momentum, according to Dr. Charles Koh, a reproductive specialist at Columbia St. Mary’s. At the moment, transvaginal laparoscopy is only available in two places in the U.S., one of which is Milwaukee, where Dr. Koh has been performing the procedure for two years.

Charles Koh, M.D., reproductive specialist at Columbia St. Mary's "What's news about this is that we are able to look into the pelvis in a relatively comfortable and painless procedure that lasts all of five minutes in the office."

Fertiloscopy and ovarian cancer
The trade name, Fertiloscopy, correctly implies that it is a cutting-edge treatment for infertility, but the procedure could be a revolutionary step forward in diagnosing ovarian cancer, Dr. Koh said.

“At the moment, there’s no (simple) test that’s good enough (to conclusively detect it). Ultrasound can be done to look at the ovaries but it cannot distinguish between a benign cyst and one that may be cancerous,” he said. “This procedure allows direct visualization of the ovary.”

Fertiloscopy and fertility treatments
Fertiloscopy also can save women from a variety of fertility-related treatments. Fertiloscopy, with the transvaginal mini-laparoscope, accomplishes in one procedure and in the doctor’s office what previously required four separate procedures in an operating room.

Fertiloscopy replaces hysteroscopy (examination of the inside of the uterus), laparoscopy (examination of the pelvis), salpingoscopy (examination of the fallopian tube), and confirms whether the fallopian tubes are blocked (hysterosalpingography).

Hysteroscopy is used to find polyps, fibroid tumors (which are benign) and/or scarring, all of which can cause infertility or repeated miscarriages. Laparoscopy focuses on the quality of the fimbriae of the fallopian tubes. The fimbriae, which Dr. Koh described as “the Hoover of the body,” are responsible for picking up an egg and moving it along the fallopian tubes. It is this procedure that also allows a clear look at the ovary, and can pick up fine adhesions that can only be seen underwater.

The Fertiloscopy can also help detect endometriosis on the ovary and verify whether follicle development is occurring. The follicle contains the egg prior to ovulation.

Examining the back of the uterus can determine the presence of uterine fibroids, as well as endometriosis; examination of the peritoneum (pelvic lining) can also diagnose endometriosis of the pelvis.

During the procedure, Dr. Koh can push blue dye into the uterus. If the dye emerges through the fallopian tubes, he knows that they are open. Inserting the mini-telescope into the fallopian tube, he also can tell whether the mucosa and folds are normal, and detect the presence of an infection.

The Fertiloscopy can also help detect endometriosis on the ovary and verify whether follicle development is occurring.

While the procedure is occurring, Dr. Koh can, if necessary, perform simple treatments of ovarian or tubal adhesions. He also can drill the ovaries of women with polycystic ovarian syndrome, a disorder characterized by the lack of, or infrequent, menstrual periods.

Dr. Koh says that in treating infertility, he uses the procedure prior to a woman undergoing in-vitro fertilization, in which the egg is fertilized outside the body and implanted in the uterus.

“A lot of doctors just go straight for IVF and feel it can override everything,” he said. “However, IVF results are poor if there are undetected polyps or adhesions in the uterus or if there’s untreated endometriosis.”

Dr. Koh said the procedure is extremely cost-effective, citing a cost of approximately $1,000 for a full profile in his office. A laparoscopy performed in the operating room, by comparison, costs at least $5,000.

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