Infertility is an issue that can be heart-breaking for a family, difficult to discuss socially, and hard to emotionally process as a woman. It’s also an issue that impacts 6.1 million American women, ages 15-44 (according to www.womenshealth.gov, a website run by U.S. Department of Health and Human Services).
Being such a widely experienced issue, we recently consulted one of our state’s leading experts on addressing- and resolving- infertility. Here, Dr. Hugo Ribot, surgeon and co-founder with Dr. Malcolm Barfield of the Georgia Advanced Surgery Center for Women, weighs in on infertility and a largely unlooked, yet easily resolved, cause.
the common issue
LBD/LRW: Dr. Ribot, do you see infertility as an increasing phenomenon?
Dr. Ribot: The incidence of infertility is not necessarily more common as the years go by, but the reason it seems more common now is that maternal age has crept further and further into late 30s and early 40s for childbirth, which means we’re getting a decline in ovarian reserve. A woman can be in great shape, eat organically, not have a single wrinkle, and still have ovaries that produce eggs that are harder to fertilize.
LBD/LRW: Infertility can also be the result of the male partner, correct?
Dr. Ribot
Dr. Ribot: Absolutely. Thirty to 40 percent of the time, it’s a female factor. But, 30 to 40 percent of the time it’s a male factor. And then 10 to 15 percent of couples have unexplained infertility. They’ve been tested from head to toe and everything seems normal: eggs are released, they’re timing intercourse correctly, there’s regular ovulation, and still no pregnancy.
This is a discouraging category for a couple because if they’ve truly been tested from A to Z, there’s not a lot of hope for pregnancy unassisted.
the causes
LBD/LRW: What are the primary causes of infertility?
Dr. Ribot: Causes can vary, but a very common cause of infertility— and often of unexplained infertility–is endometriosis. Here’s why: A lot of more educated ladies who have heard of endometriosis assume it entails painful periods or painful intercourse. That’s actually not the case in many women. Dr. Barfield and I (us “old guys”) have been doing laproscopic surgeries for many, many years, and we’ve seen many women who do not experience pain, are not surviving on Advil. The only way endometriosis has manifested itself is that they couldn’t get pregnant.
LBD/LRW: What are the “hidden” signs of endometriosis?
Dr. Ribot: Here are the symptoms, but not all of these may be present. Painful periods and painful intercourse are common. But other lesser known symptoms include painful bowel movements, especially during periods, or past experience with painful periods.
If you don’t have any symptoms currently, but when you were 14 you did, or if you had to be put on the pill as a teenager due to painful periods, or if your mom had to take you to the doctor because you were crying from pain during your period, those are all signs–even if you haven’t had pain in decades. And sometimes there is no pain, only a failure to get pregnant.
LBD/LRW: Isn’t endometriosis something that is considered first in a woman who is having difficulty conceiving?
Dr. Ribot: Surprisingly, no. The reason is that the only way to truly discover endometriosis is through laparoscopy: the use of a tiny scope inserted through the
Laparoscopy in action.
belly button that has a high-def camera attached that shows a blown-up, 3D image of the entire abdomen and pelvis. This used to be an automatic part of an infertility workup; doctors automatically scoped everyone to look for blockage and endometriosis.
But now that the success rate of In Vitro Fertilization (IVF) is so high (there used to be a 10 to 15 percent success rate, but now it’s almost 60 percent), the same doctors who used to be the super stars of minimally invasive surgeries like laparoscopy, go straight to In Vitro for two reasons: First, to be honest, it’s a very lucrative procedure, costing $10-12K per cycle—sometimes more; and second, they know that, despite the high cost, it usually works. So, they go straight to the big guns to get everyone pregnant. But, a simple outpatient procedure may have been all that was needed. Truly.
the solution
LBD/LRW: So if a couple is struggling with infertility and frustrated at their options (or lack thereof), what should they do next?
Dr. Ribot: Schedule a laparoscopy procedure with a surgeon who specializes not only in laparoscopy, but in also excising and removing endometriosis. We see women all the time who have tried Clomid, fertility treatments, the works. Then they come to us as a last resort before In Vitro, and we scope them, find and remove endometriosis, and bam! They get pregnant. We see this, literally, all the time.
LBD/LRW: We know there are different ways to “remove” endometriosis, but excising it is the most effective in resolving infertility, correct?
Dr. Ribot: Absolutely. Unless a surgeon does laparoscopy very often, they’re not comfortable excising (cutting out) the endometriosis, which is the only way to truly remove the endometriosis below the surface that may be causing the infertility. Most surgeons will simply do ablasian or coterization, where they timidly burn off the endometriosis on the surface. This is a terrible way to approach it because endometriosis is like an iceberg: most of it resides below the surface.
LBD/LRW: What’s involved with excising endometriosis? Is it painful?
Dr. Barfield
Dr. Ribot: Dr. Barfield and I do this day in and day out. It’s a brief outpatient surgery, covered by insurance, where we make a tiny incision inside the belly button, pass a tiny scope (5 milimeters) into the abdomon, see inside with the scope’s high-def camera, blow it up on our screen, and then use tiny instruments to remove tissue without disturbing any blood vessels or causing any bleeding.
We literally remove all traces of endometriosis. Then we put in tiny stitches, wake up the patient, and they’re out of the office in 30 minutes. Within a couple of days, they’ve fully recovered. Much less recovery, stress and cost than IVF!
And the best part is that within a matter of months, these women get pregnant unassisted!
the success
LBD/LRW: And you honestly see success with this all the time?
Dr. Ribot: All the time. One of our patients is a nurse. She went to infertility specialists at age 32 or 33. They told her she had a diminished ovarian reserve and did insemination and a score of other very expensive procedures–everything short of In Vitro. They she came over to me. We scoped her and found endometriosis all over. We excised the endometriosis, and boom, she got pregnant. After that pregnancy, we scoped her again when she wanted to get pregnant a second time and found a few more little new spots in different areas and removed them. Bam, she got pregnant with twins at age 36. Unassisted!
LBD/LRW: The moral of the story?
Dr. Ribot: Definitely try this first. It’s a totally clean, easy, safe outpatient surgery covered by insurance. To date, we have zero percentage of complications, which very few surgeons in the nation can say. Zero percentage of infections, organ injury, hemorrhage, readmission to the hospital, transfusion needed, etc: zero percent since day one.
LBD/LRW: So, to summarize, the risks are incredibly low. And the payoff is incredibly high.
Dr. Ribot: Absolutely.
the guide
Dr. Ribot practices at the state’s leading surgery center specifically designed for women, Georgia Advanced Surgery Center for Women:
958-A Joe Frank Harris Parkway
Building 2, Suite 107
Cartersville, GA 30120
678-605-9399
www.ga-advancedsurgerycenter.com
childhood cancer survivor and former Make-A-Wish recipient. 
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LBD|LRW: 
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the gig:
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