Lasers in infertility

Lasers have been used in fertility surgery for the past two decades. This article reviews the development of different wavelength lasers, the different tissue effects and their applications in infertility surgery. The CO2 laser remains the most precise laser, especially in the ultrapulse mode, for the division of adhesions and the accurate and safe vaporization of deposits of endometriosis. The neodymium:YAG laser, because of its greater depth of penetration, is more suited to hysteroscopic surgery, and attempts to focus the energy by sapphire tips and sculpted quartz fibres merely enable tissue to be incised by a thermal effect. Carbon dioxide laser energy is strongly absorbed by the water molecule and is rendered ineffective in the presence of blood so the visible light lasers, argon and potassium titanyl phosphate (KTP/532) lasers, are more suitable for the treatment of ovarian endometriomas and ectopic pregnancies. Techniques and results of laser surgery in endometriosis, tubal surgery, ectopic pregnancy and polycystic ovarian syndrome are reviewed. The main advantage of the various lasers is that they allow fertility surgeons to perform operative surgery by the minimally invasive approach of laparoscopy rather than laparotomy.