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Pinar Kodaman, MD, PhD, is a reproductive endocrinologist and infertility specialist with a focus on fibroids, endometriosis and other gynecologic issues that can cause infertility.

Photo by Robert A. Lisak

Overview

In the journey through infertility treatment, some women learn they have a gynecological issue interfering with their ability to conceive that can be corrected through a surgical procedure.

The specialists in Yale Medicine’s Reproductive Endocrinology & Infertility have expertise in minimally invasive gynecological surgery that often resolves a woman’s infertility problem so that she can successfully conceive and carry a child.

“What’s unique is the continuity of care we offer patients,” says Pinar Kodaman, MD, PhD, director of the Advanced Endoscopic Reproductive Surgery Program. “A woman might come to us for management of a condition such as fibroids. She will have surgery, and then we will work with her at the Yale Fertility Center to help her achieve pregnancy. Down the road, if she needs a hysterectomy, we can do that, too.” 

What are the benefits of minimally invasive surgery for reproductive health?

New surgical techniques and technologies allow the majority of gynecologic surgical procedures to be performed in a minimally invasive fashion. This approach uses small (or sometimes no) incisions, is less invasive than traditional open surgery and often allows patients to go home the same day. Recovery and healing tend to be quicker, too.

Minimally invasive surgery is often appropriate for women with such conditions as ovarian cysts, scar tissue, blocked Fallopian tubes, polyps, endometriosis (a painful disease in which uterine tissue grows outside the uterus) and developmental anomalies of the reproductive tract. It’s also used for fibroids, which are benign smooth muscle growths of the uterus that are a common cause of infertility, pregnancy loss and pregnancy complications. 

What minimally invasive gynecological procedures are used to treat women with infertility?

Minimally invasive surgery is not always the most appropriate option for every candidate. After evaluating your condition, your surgeon will discuss the best option for you. Procedures that may be used to correct conditions that are interfering with a woman’s ability to get or stay pregnant include the following:

  • Laparoscopy. This minimally invasive surgical technique involves making small incisions through the abdomen to insert a tiny laparoscope (a tube with a light and camera lens at the tip) to examine organs and perform a variety of procedures to restore, enhance and preserve fertility
  • Robot-assisted laparoscopy. Robot-assisted surgery, using the daVinci Surgical System®, provides expanded visualization, allowing surgeons to perform procedures that might be difficult to do with traditional laparoscopy alone.
  • Hysteroscopy. This surgical procedure may be used to diagnose and treat many uterine disorders. An instrument called a hysteroscope is inserted through the vagina to capture and transmit images of the canal of the cervix and the interior of the uterus to a television screen. In addition to diagnosing intrauterine problems, the hysteroscope can be used to treat abnormal findings at the time of the procedure. For example, if a biopsy or other treatment is needed, small instruments can be passed through the hysteroscope.

Deciding which type of minimally invasive surgery is best for each patient depends on a number of factors, Dr. Kodaman says. 

“There are usually more incisions and longer time under anesthesia with robot-assisted laparoscopy, so we don’t use it unless there is a clear need. However, the wristed instruments with the robotic system allow us to do difficult cases in a minimally invasive way that we would otherwise have to do with open surgery.”

What stands out about Yale Medicine’s approach to minimally invasive gynecologic surgery for the treatment of infertility?

Yale Medicine Reproductive Endocrinology & Infertility offers an array of services not commonly found elsewhere. The fact that many reproductive problems can be treated with a minimally invasive approach means that women can go home the same day and return to work sooner. 

Our highly specialized physicians are known for expertise in handling difficult or challenging conditions. Notes Dr. Kodaman, “We are a referral center for complex cases, particularly when fertility preservation is required.”

But the biggest benefit, Dr. Kodaman says, is the continuum of care. “We can diagnose and surgically treat the problem. If needed, we can offer fertility programs,” she says. “Our doctors will stay with their patients throughout the process.”