Laser in Subfertility

In: Infertility and Assisted Reproduction · 2008 · pp. 132–136 · doi:10.1017/cbo9780511547287.017 · W419857881
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This review describes laser applications in subfertility surgery, focusing on endometriosis treatment, intrauterine adhesions, myomectomies, and septal resections using various laser types like Nd:YAG, KTP, diode, and CO2 lasers.

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This chapter discusses the role of laser devices in subfertility surgery, outlining the physical principles of laser light generation and summarizing evidence for common laser applications used in infertility evaluation and treatment. It notes that past debates focused on the lack of robust multicenter randomized trials demonstrating laser superiority over other surgical approaches, alongside the practical reality that surgeons often use the tool they are most comfortable with. The chapter provides an evidence-based but non-systematic overview, with examples and references across gynecologic procedures, while implicitly acknowledging limitations in the strength of available comparative data. Relevance to endometriosis: the chapter references endometriosis-related surgical approaches using laser laparoscopy (including studies of laser laparoscopy for pelvic endometriosis with infertility and pelvic pain) as part of the broader discussion of pelvic surgery in subfertility, though the chapter’s main focus is laser technologies and their applications in fertility-conserving/fertility-enhancing operations.

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Abstract

This chapter gives a brief description of the physical principles and the applications of the most commonly used lasers in subfertility surgery. The most common application of laser in subfertility surgery is endometriosis. The role of extensive surgery to treat deeply infiltrating endometriosis is debatable with the exception of endometriomas where excision seems to be superior to ablation regarding spontaneous pregnancy rate. The Nd:YAG laser has been used successfully to treat intrauterine adhesions with encouraging reproductive outcomes. The Nd:YAG laser has been widely used for hysteroscopic myomectomies as one- or two-stage procedure. Interstitial myolysis using a bare optic fiber of KTP, YAG, or diode laser has been reported as resolving symptoms and leaving a uterus capable of child bearing. The KTP or the Nd: YAG is the laser of choice for uterine septums, and the CO2 laser is used for vaginal septums.
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- Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - 6 Evaluation of the Infertile Female - 7 Fertiloscopy - 8 Microlaparoscopy - 9 Pediatric and Adolescent Gynecologic Laparoscopy - 10 Laparoscopic Tubal Anastomosis - 11 Tubal Microsurgery versus Assisted Reproduction - 12 The Future of Operative Laparoscopy for Infertility - 13 Operative Hysteroscopy for Uterine Septum - 14 Laser in Subfertility - 15 Ultrasonography of the Endometrium for Infertility - 16 Ultrasonography of the Cervix - 17 Transrectal Ultrasonography in Male Infertility - 18 The Basic Semen Analysis: Interpretation and Clinical Application - 19 Evaluation of Sperm Damage: Beyond the WHO Criteria - 20 Male Factor Infertility: State of the ART - 21 Diagnosis and Treatment of Male Ejaculatory Dysfunction - 22 Ovulation Induction - 23 Clomiphene Citrate for Ovulation Induction - 24 Aromatase Inhibitors for Assisted Reproduction - 25 Pharmacodynamics and Pharmacokinetics of Gonadotrophins - 26 The Future of Gonadotrophins: Is There Room for Improvement? - 27 Ovarian Hyperstimulation Syndrome - 28 Reducing the Risk of High-Order Multiple Pregnancy Due to Ovulation Induction - 29 Hyperprolactinemia - 30 Medical Management of Polycystic Ovary Syndrome - 31 Surgical Management of Polycystic Ovary Syndrome - 32 Endometriosis-Associated Infertility - 33 Medical Management of Endometriosis - 34 Reproductive Surgery for Endometriosis-Associated Infertility - 35 Congenital Uterine Malformations and Reproduction - 36 Unexplained Infertility - 37 “Premature Ovarian Failure”: Characteristics, Diagnosis, and Management - PART III ASSISTED REPRODUCTION - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References from PART II - INFERTILITY EVALUATION AND TREATMENT Published online by Cambridge University Press: 04 August 2010 Book contents - Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - 6 Evaluation of the Infertile Female - 7 Fertiloscopy - 8 Microlaparoscopy - 9 Pediatric and Adolescent Gynecologic Laparoscopy - 10 Laparoscopic Tubal Anastomosis - 11 Tubal Microsurgery versus Assisted Reproduction - 12 The Future of Operative Laparoscopy for Infertility - 13 Operative Hysteroscopy for Uterine Septum - 14 Laser in Subfertility - 15 Ultrasonography of the Endometrium for Infertility - 16 Ultrasonography of the Cervix - 17 Transrectal Ultrasonography in Male Infertility - 18 The Basic Semen Analysis: Interpretation and Clinical Application - 19 Evaluation of Sperm Damage: Beyond the WHO Criteria - 20 Male Factor Infertility: State of the ART - 21 Diagnosis and Treatment of Male Ejaculatory Dysfunction - 22 Ovulation Induction - 23 Clomiphene Citrate for Ovulation Induction - 24 Aromatase Inhibitors for Assisted Reproduction - 25 Pharmacodynamics and Pharmacokinetics of Gonadotrophins - 26 The Future of Gonadotrophins: Is There Room for Improvement? - 27 Ovarian Hyperstimulation Syndrome - 28 Reducing the Risk of High-Order Multiple Pregnancy Due to Ovulation Induction - 29 Hyperprolactinemia - 30 Medical Management of Polycystic Ovary Syndrome - 31 Surgical Management of Polycystic Ovary Syndrome - 32 Endometriosis-Associated Infertility - 33 Medical Management of Endometriosis - 34 Reproductive Surgery for Endometriosis-Associated Infertility - 35 Congenital Uterine Malformations and Reproduction - 36 Unexplained Infertility - 37 “Premature Ovarian Failure”: Characteristics, Diagnosis, and Management - PART III ASSISTED REPRODUCTION - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References INTRODUCTION The use of laser for fertility-conserving and fertility-enhancing surgery has gone through extensive debate during the past two decades. Most of the arguments against was the lack of concrete evidence for its superiority in the form of multicenter randomized trials that would justify the cost of this highly efficient precise surgical instrument (1). However, the efficacy and the ease of use have made the laser one of fertility surgeon's favorite. As with all surgical procedures, the most suitable is the one the surgeon is most comfortable with. Which tool a surgeon should use for the operation remains the subject of randomized trials to be conducted. In this chapter, we are going to give a brief description of the physical principles and the applications of the most commonly used lasers in subfertility surgery and provide evidence when it is available. PHYSICS Laser stands for light amplification by stimulated emission of radiation. The principle of the production of a laser beam is based on Einstein's theory of stimulated emission; an atom can be stimulated by an energy form – heat, electrical discharge, or photon bombardment – and stays stimulated for a calculated period of time. It then returns to its unstimulated state by emitting a photon, which is practically a light wave packet, one wave of light characteristic of the quality of the atom that was stimulated. - Type - Chapter - Information - Infertility and Assisted Reproduction , pp. 132 - 136Publisher: Cambridge University PressPrint publication year: 2008 Laser hysteroscopic myomectomy guided by laparoscopically assisted intra-abdominal sonohysterography (LHMY-GLAIS): a preliminary report. 2001;17(3): 79–86.Google Scholar et al. Carbon dioxide laser and electrosurgical wound study with an animal model. A comparison of healing pattern and tissue damage in peritoneal tissue. Am J Obstet Gynecol 148:327.CrossRef , , et al. Surgical treatment of endometriosis via laser laparoscopy. Fertil Steril 45:778–83. , , . . Green Top Guideline No 24. The Investigation and management of Endometriosis RCOG, October 2006. Excisional surgery versus ablative surgery for ovarian endometriomata (Cochrane Review). Cochrane Lib 2006;(3).Google Scholar , , , , . The endometriosis syndromes: a clinical classification in the presence of aetiological confusion and therapeutic anarchy. Hum Reprod 2004;19:760–8.CrossRefGoogle ScholarPubMed . Laser laparoscopy in the treatment of endometriosis. A 5-year study. Br J Obstet Gynaecol 1990;97(2):181–5.CrossRefGoogle ScholarPubMed . Techniques for pelvic surgery in subfertility. Cochrane Database Syst Rev. 2006;(2).CrossRefGoogle ScholarPubMed , , et al. Pelviscopic adhesiolysis in chronic pelvic pain—laser versus conventional techniques. Geburtshilfe Frauenheilkd 1992;52(1):47–50.CrossRefGoogle ScholarPubMed . Techniques for pelvic surgery in subfertility (Cochrane Review). Cochrane Database Syst Rev 2006; (2).CrossRefGoogle Scholar , , , . Adhesion reformation after reproductive surgery by videolaseroscopy. Fertil Steril 1990;53:1008.CrossRefGoogle ScholarPubMed , , , . Argon laser laparoscopy for treatment of pelvic endometriosis associated with infertility and pelvic pain. J Gynecol Surg 1991;7(1):27–32.CrossRefGoogle ScholarPubMed . The value of two stage laser treatment for severe Asherman's syndrome. Br J Obstet Gynaecol 1996;103(12):1256–8.CrossRefGoogle ScholarPubMed . Neodymium: YAG laser hysteroscopy in large submucous fibroids. Fertil Steril 1990;54:999–1003.CrossRefGoogle ScholarPubMed . , , , . New therapeutic technique for treatment of uterine leiomyomas using laser-induced interstitial thermotherapy (LITT) by a minimally invasive method. Lasers Surg Med 1998;22(3):171–8.3.0.CO;2-M>CrossRefGoogle Scholar . Laser hair reduction in the hirsute patient: a critical assessment. Hum Reprod Update 2002;8(2):169–81.CrossRefGoogle ScholarPubMed , . . Hysteroscopic metroplasty of the Class Va uterus with preservation of the cervical septum. Fertil Steril 1999;72(5):942–5CrossRefGoogle ScholarPubMed . Transvaginal, ultrasound-guided, ovarian, interstitial laser treatment in anovulatory women with clomifene-citrate-resistant polycystic ovary syndrome. BJOG 2006;113(7):810–16.CrossRefGoogle ScholarPubMed . No advantage of laser assisted hatching over conventional intracytoplasmic sperm injection; a randomized controlled trial. J Exp Clin Assist Reprod Biomed Central. et al. Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Laser in Subfertility - - Book: Infertility and Assisted Reproduction - Online publication: 04 August 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Laser in Subfertility - - Book: Infertility and Assisted Reproduction - Online publication: 04 August 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Laser in Subfertility - - Book: Infertility and Assisted Reproduction - Online publication: 04 August 2010

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