In gynecologic surgery, precision makes the difference. And when the goal is fertility, every detail matters.
A complex gynecologic case, with prior interventions and associated complications. A refined surgical solution, with one clear objective: increasing the chances of embryo implantation.
Case context
A 39-year-old patient presented for re-evaluation before an embryo transfer. The situation was complicated by a fibromatous uterus and post-surgical complications that reduced her chances of pregnancy.
Investigations revealed
- 🔹 4 uterine fibroids — one about 8 cm, compressing the uterine cavity
- 🔹 Bilateral hydrosalpinx — dilation of both fallopian tubes, tubal blockage
- 🔹 Status post open myomectomy — with a "frozen pelvis" (severe adhesions from prior surgery)
Source: TikTok @dr.alinconstantin
The therapeutic strategy chosen
After careful evaluation, we chose a minimally invasive surgical approach, designed to optimize the chances of success for the fertility procedure and to reduce risk for the patient.
What the surgery involved
- ✔️ Laparoscopic myomectomy with reconstruction of the uterus
- ✔️ Bilateral salpingectomy (removal of the tubes with hydrosalpinx)
- ✔️ Minimally invasive technique, with careful dissection in a pelvis full of adhesions
Why salpingectomy and not myomectomy alone
Hydrosalpinx (a blocked, distended fallopian tube) is known to significantly reduce implantation rates in IVF procedures. The fluid inside the distended tube has a toxic effect on the transferred embryo and "leaks" back into the uterine cavity.
Removing both tubes affected by hydrosalpinx before embryo transfer is the international recommendation (ESHRE / ASRM guidelines) to maximize chances of success.
Benefits for the patient
- Restoration of uterine architecture — a cavity optimized for implantation
- Elimination of toxic factors (hydrosalpinx fluid) that were compromising the embryo
- Reduced risk of later complications (torsion, infection)
- Faster recovery compared with traditional open surgery
The laparoscopic approach allowed a favorable postoperative course, with reduced pain and rapid return to daily activities, preparing the patient for the next stage of the fertility process.
Why complex cases need surgeons with specific experience
A pelvis with severe adhesions from prior surgery (a "frozen pelvis") is one of the most difficult surgical situations. Normal anatomical structures are distorted. The risks of injury to adjacent organs (bowel, ureter, bladder) are significantly increased.
In these cases, choosing a surgeon with documented experience in minimally invasive surgery for the complex pelvis is not optional — it is critical for patient safety.
📌 When surgical re-evaluation before IVF is recommended
If you have one or more of the following:
- Uterine fibroids compressing the cavity (>4 cm or submucosal)
- Unilateral or bilateral hydrosalpinx
- History of gynecologic surgery (myomectomy, ovarian cystectomy, endometriosis surgery)
- Failed IVF cycles without an obvious cause
Surgical re-evaluation before a new transfer can make the difference between repeated failure and a successful pregnancy.
📄 Clinical source: TikTok caption by Dr. Alin Constantin (February 27, 2026) · Medical context (hydrosalpinx pathophysiology, ESHRE guidelines) added for patient education
