Surgical Correction of Infertility

Many infertility causes — including endometriosis and fibroids — can be resolved by minimally invasive procedures completed by world-class surgeon Dr. Saji Jacob.

Many infertility causes can be corrected by surgery, and GoFertility in St. Louis specializes in a multitude of surgical procedures to put our patients on the path to fulfilling their dream of having a baby.

Dr. Saji Jacob — one of a select few dual board-certified OB/GYN doctors and high-complexity clinical lab directors in the nation — is likewise certified as a robotic surgeon. His immense knowledge and expertise in this area has led to him serving as a proctor to train doctors in robot-assisted gynecological procedures.

Since 2011, GoFertility (also known as CRMRS) has beaten the national pregnancy rate per embryo transfer every single year. Our exemplary care, patient-centered approach and consistent results helped us earn selection as one of the 50 best fertility clinics in the country in 2023, according to Newsweek. Dr. Jacob and his team have completed more than 1,000 complex robotic surgeries to help correct infertility issues for patients dealing with the following:

• Advanced-stage endometriosis
• Myomectomies or fibroid removal surgery
• Ovarian cyst removal
• Tubal microsurgical reanastomosis

An Industry Leader in Endometriosis Treatment

Diagnosing and treating patients with endometriosis is one of GoFertility’s most significant concentrations. Endometriosis is a condition often causing pelvic pain and is typically linked with menstrual-cycle pain that’s much worse than a normal period. Common symptoms of endometriosis include:

• Pelvic, stomach and lower back pain: Pelvic discomfort and cramping may begin prior to a period and last several days into a period. This pain can be debilitating and affect quality of living.
• Pain during or after sexual intercourse
• Pain during urination or bowel movements before or during a period
• Abnormal bleeding: Excessive amounts of blood during periods or between cycles is a common symptom of endometriosis
• Infertility: Many female patients discover they have endometriosis when they are unable to become pregnant
• Additional symptoms such as fatigue, nausea, diarrhea, constipation or bloating, usually before or during periods

Endometriosis is caused by tissue similar to the uterus’s inner lining growing outside the uterus. This unwanted tissue builds up over time in places it doesn’t belong, irritating surrounding tissue and causing scars and inflammation. Up to 11 percent of women between the ages of 15 and 44 are afflicted by endometriosis, according to Johns Hopkins Medicine. And up to 60 percent of women with infertility have endometriosis.

Debilitating pelvic pain before and during menstrual cycles that is much worse than normal period discomfort is one of the most common endometriosis symptoms. While the exact cause of endometriosis is unknown, immune disorder is a likely culprit.

In all women, about 30 percent of blood and endometrial tissue goes through the fallopian tubes into the pelvis during the period. The body knows this blood and tissue is in the wrong place and will absorb the blood and eat away the tissue. By the end of the period, everything is cleaned out inside. This happens in all women every month.

In patients who develop endometriosis, their body is not able to take care of this blood and tissue in the pelvis. The endometrial tissue implants to whatever it can find, including ovaries, tubes, the back side of the uterus, bowel, bladder, etc. It grows and bleeds every period, causing a chronic inflammatory condition in the pelvis. Endometriosis negatively affects each of the four key elements of getting pregnant:

1. It can grow on or inside the ovaries, causing destruction of eggs in the ovaries or preventing ovulation.

2. It can grow inside and outside the fallopian tubes, which causes tubal occlusion or tubal dysfunction and carries risk factors.

3. Endometriosis produces toxins which can affect the quality of eggs, embryos and even sperms in the male partner.

4. Endometriosis alters the normal lining of the uterus, increasing the rate of miscarriage by at least 15 percent. These endometrial changes, called “stippling,” can be seen during a hysteroscopy procedure that is routinely done at CRMRS and takes just 10 minutes.

Patients who come to GoFertility with endometriosis of any stage will receive excellent care, as our team is highly trained to treat complex cases of this disease. When you visit our center in Creve Coeur — with new patients typically able to make an appointment within a week — we will assess the severity of the disease by testing hormones, performing an ultrasound and possibly conducting a laparoscopy.

Once the endometriosis diagnosis is confirmed, Dr. Jacob performs a minimally invasive robot-assisted surgery to remove all lesions. Dr. Jacob is a renowned robotic surgeon and by using this type of cutting-edge procedure, he has a greater range of motion, improved dexterity and access. An estimated 50 percent of lesions are colorless and sometimes missed during laparoscopy, which is why choosing a highly experienced surgeon like Dr. Jacob is important.

After surgery is completed, patients will typically begin in-vitro fertilization (IVF) cycles to start the process of having a baby. Other next steps to ensure patient health may include hormone replacement therapy, pain control, assisted reproductive treatments or periodic ultrasounds to check progress.

Surgical Treatment of Myomectomies

Dr. Jacob is one of a handful of doctors who utilizes robot-assisted surgery to treat myomectomies. A myomectomy is a surgical procedure to remove fibroids from the uterus. Unlike a hysterectomy — which removes the entire uterus — a myomectomy hones in on taking out the fibroids, or common growths. Patients don’t always have symptoms when uterine fibroids form. If they do, those symptoms can include:

• Excessive bleeding during periods
• Longer, more frequent or painful periods
• Pelvic discomfort
• Stomach or lower back discomfort
• Constipation
• Growing stomach area
• Pressure effects on the urinary bladder and rectum; this results in increased frequency of urination, constipation or diarrhea

If you’re concerned you need treatment for endometriosis or require a myomectomy, hysterectomy or something else, we’re here to help. Our compassionate, knowledgeable team has assisted hundreds of women get out of pain and get on the path to fulfilling their dream of having a baby.

We’ll guide you through potential treatments. And if surgery is ultimately prescribed for your situation, you can rest assured knowing you’re in the world-class hands of Dr. Jacob and our team of highly trained professionals.