Infertility, Uterine Prolapse and Hysteropexy
Patients who have a prolapsed uterus and infertility can sometimes be treated with a uterine suspension i.e. hysteropexy to restore the uterus back to a more normal anatomical position and optimize conditions for sperm and fertilization.
What is uterine prolapse?
Uterine prolapse is defined as a lack of support of the uterus due to a break or compromise of the supporting ligaments known as the uterosacral ligaments. When these ligaments are compromised, the uterus descend the length of the vagina. Over time the uterus can descend so it is protruding from the vaginal opening ie outside of the body.
Can a prolapsed uterus affect fertility?
It has been suggested that a patient with prolapsed uterus can have difficulty getting pregnant and most specialist can explain this phenomena by the shear fact that a prolapsed uterus is near, at or beyond the opening of the vagina. The prolapsed uterus and vagina does not make for a great environment for sperm as deposited perm when exposed to air will dry and die. This is not a fallacy but a fact. Sperm thrives in a moist warm place like the deeper aspects of the vagina. If the uterus is prolapsing out of the vagina often much of the deposited sperm is pushed outside of the vagina and exposed to air and will die. This reduces the chance of getting pregnant. Elevation of the uterus allows for deeper deposit of the sperm and this optimizes the environment so the sperm will thrive for up to 5 days.
How is the surgery performed?
There are many ways of supporting the uterus including surgery through the vagina and using one’s original ligaments called the sacrospinous ligament surgery, using one’s original ligaments i.e. uterosacral ligament suspension, round ligament suspension known as the Gilliam procedure, however the most durable procedure with the highest cure rate is the sacrocolpohysteropexy. This type of hysteropexy requires using either cadaver, pig or cow tissue or a piece of synthetic mesh. Drs Miklos & More have been trained to do all the above techniques but over the last 20 years of surgery they have decided to use the sacrocolpohysteropexy because of its higher success rate. Drs’ Miklos and Moore have been performing this procedure for almost 20 years and have a > 98% cure rate.
The surgery is done through miniature incisions in the belly wall aka laparoscopically and tissue or mesh is sutured to the backside of the uterus and then the suspension tissue/mesh is then suspended with suture to the sacrum i.e. tailbone. This is not a new surgical technique but instead one of the most studied and commonly used techniques in the world. However very few surgeons have the experience and expertise Drs Miklos & Moore have and performing this surgery laparoscopically. Many surgeons still do the surgery through a large incision.
How long does the surgery take?
Most surgeons require approximately 2-4 hours to do a hysteropexy but in the experienced hands of Drs Miklos and Moore the procedure usually takes 30 minutes.
What complications can occur during the surgery?
Complications can occur during any operative procedure however in the hands of Drs Miklos & Moore the risk of complications include:
Chance of a large incision (<1/500 Dr M & M have never had this complication)
Chance of a hysterectomy (<1/500 Dr M & M have never had this complication)
Injury to bowel (<1%)
Injury to bladder (<1%)
Injury to ureter (<1%)
Blood transfusion (<1%)
What is the chance of surgical success?
Drs Miklos and Moore surgical success rate of uterine suspension is 98% and if the surgery fails in the first 5 years they will re do the surgery for no out of pocket surgeon’s fee (if you had a Caesarean Section and not a vaginal birth). Surgical success means the uterus does not descend again and it does not mean you did get pregnant.
What is the chance of fertility?
Because the causes of infertility are numerous and diverse and can affect both the woman and the man it is impossible to tell a patient what the success rate of getting pregnant is after a uterine suspension. No one can predict the chance of fertility success. However if you suspect uterine prolapse and you have tried everything as suggested by your gynecologist or reproductive endocrinologist or infertility specialist then consider a uterine suspension surgery.
Drs Miklos & Moore have operated on patients form all 50 states and 54 countries and they have had patients from all over the world (Malta, Italy, Africa, USA, Mexico ) get pregnant after a hysteropexy.
If I get pregnant can I deliver my baby vaginally or should I get a Caesarean Section?
This is a great question and the answer is dependent upon who you talk to, but most reconstructive surgeon would tell you to be safe and get a Caesarean Section. Why? Because the trauma of a vaginal birth can potentially compromise the tissue or mesh supporting your uterus and then you have a greater chance of having prolapse again and will need another surgery. By delivering via C-section the chance of uterine support compromise decreases and this decreases the need for another prolapse surgery.
How do I contact Drs Miklos & Moore?
Drs Miklos & Moore can usually accommodate most patients with 2-4 weeks for a consultation in either Atlanta or Beverly Hills. Please click here:
https://www.miklosandmoore.com/cosmetic-surgeon-consultation-atlanta/
to see about scheduling an appointment for an evaluation for uterine prolapse, infertility and hysteropexy.