We offer a full spectrum of basic and specialized obstetrics & gynaecological treatments, including minimally invasive procedures.

Hysteroscopy is the visual overview of the interior of the uterus (hysteria) that reveals and / or treats the pathology of the interior of the uterus (endometrium), the area where the fetus is developed.

Operative Hysteroscopy Indications for applying Hysteroscopy:

As well as, uterine anatomical abnormalities, such as

During hysteroscopy there are no surgical incisions but a special instrument (hysteroscope) is inserted through the vagina and the endocervix, while light anesthesia is necessary. The recovery is immediate and the woman can go back to her normal activities on the same day.

Therapeutic hysteroscopy, although simple in technique, is reliable and efficient, economical and easily tolerated, while at the same time there is a possibility of immediate pregnancy.

Especially in cases of repeated unsuccessful In Vitro Fertilization attempts, hysteroscopy is particularly useful since in this way uterine anatomical abnormalities of the uterine cavity are revealed which were preventing the implantation of the fertilized eggs (embryos) and the achievement of pregnancy.

Hysteroscopic correction of these abnormalities leads faster to the desired result, namely pregnancy and child-birth.

Laparoscopy is the overview of the abdomen (laparo). It is a method that can have diagnostic or therapeutic nature since it indicates any pathology of the abdomen.

With the aid of laparoscopic surgery more than the 80% of the gynecological surgical problems are now treated even those not related to infertility. Possible pathologies that are treated by laparoscopic surgery are:

Laparoscopy has replaced the traditional surgery tο a great extent and it is widely used as it offers many advantages.

Its main advantage is the absence of extensive surgical incision and its replacement by three small incisions of about 1 cm. This means minimal trauma and pain, minimal blood loss, absence of intra-abdominal adhesions as well as reduced postoperative hospitalization. In most cases recovery is immediate and return to work is possible within the next few days.

Furthermore, the absence of extensive incision has no negative aesthetic effect improving in this way the woman’s psychology and leading her to a faster recovery.

What are fibroids?

A woman’s uterus is made of muscle tissue which is called smooth muscle tissue. Fibroids (or myomas) are benign tumors in the uterine walls. They appear frequently in daughters whose mothers also had fibroids. By the age of 50 years, a large number of women (around 40-50%) will develop fibroids, which, depending on the size and location in the womb, they are likely to cause pain, heavy periods or blood between periods. They can also cause painful or frequent urination or constipation due to the pressing phenomena performed in the surrounding organs and the discomfort they create because of space occupation inside the pelvis.

Fibroids can have three types, depending on their location: submucosal, intramural and subserosal. Fibroids vary in size, ranging from a few millimeters to a few centimeters, and can either grow rapidly or remain steady in size. The development of fibroids usually decreases after menopause, because the levels of a woman’s estrogens drop.

Diagnosis of Fibroids

The best method to diagnose fibroids is a transvaginal or abdominal ultrasound. Magnetic Resonance imaging (MRI) is another useful method to diagnose fibroids, primarily for their mapping, where the boundaries are not clear or visible. Sometimes submucosal fibroids are also detected during Salpingography (specific radiological examination of the tubes and intrauterine cavity) or during a diagnostic Hysteroscopy.

How do Fibroids affect fertility?

If a fibroid grows near the entrance of the tube, it may cause tube blockage. The size, location and number of fibroids also can affect fertility and in cases of infertile women it is an important factor that should be discussed with the attending physician. Submucosal fibroids hold the major negative factor, entering the uterine cavity, disrupting its architecture, causing bleeding and altering the hormonal and secretory environment in which the embryo is implanted. All these result in difficulties in achieving pregnancy and increased incidence of abortions and / or complications during pregnancy.

Treatment of Fibroids

Fibroids can be removed surgically or laparoscopically.The open method (laparotomy) is called myomectomy. The process involves a small abdominal incision where the uterus is opened carefully and the fibroid is removed. Special care is needed to avoid injuring the fallopian tubes or other nearby organs and also caution during surgical suture so as not to form scar tissue.Laparoscopic removal is a process in which two or three small incisions are made on the lower part of the abdomen, to enter the laparoscopic instruments. The following surgical steps are similar to the open surgery, but with considerable advantages such as milder treatments, less traumatic, milder anatomical distortion of the pelvis and of course reduced postoperative pain and faster recovery time. Although various processes have been tried for the treatment of fibroids (e.g. drugs and vaccination), surgical removal remains the first choice especially in large symptomatic fibroids.

Do they re-appear even after treatment?

A significant number of women will still present fibroids even after having removed the existing ones. Therefore, after a removal surgery, a frequent medical check is important in case that any new fibroids appear. Limited chance of development or recurrence of fibroids have the women who are in menopause.

Is it necessary to remove all fibroids?

Removing fibroids is not always necessary and mainly depends on their size, their number, their location and the symptoms they cause (if and when they do). Moreover, a woman’s age and the degree of infertility are two other crucial factors that should be evaluated by the gynaecologist or the fertility specialist, together with the advantages and possible complications of a surgery.

The endometrium is the tissue that covers the uterine cavity just like a carpet where the embryo will be implanted. Endometriosis is a condition in which tissue identical to the uterine wall (endometrium) is detected out of the uterus, particularly in the pelvic cavity. This tissue can develop in organs such as the ovaries, the uterus, the intestinal and pelvic walls causing inflammation and pain.

During each cycle, when an egg is not fertilized and no implantation or pregnancy occur, the inner lining of the uterus is rejected by bleeding through the vaginal cavity (period or menstruation). But in case the wall outside the uterus is ruptured, blood cannot leave the body, thus creating inflammation and pain. Endometriosis can affect women physically, socially and also mentally. The most common symptoms are dysmenorrhea and painful ovulation, abnormal bleeding, pain during or after sexual intercourse, abdominal pain, fatigue and possibly infertility.

About 10% of women in childbearing age present endometriosis symptoms and a 30-40% of them may never be able to have children. Moreover, 50% of infertile women suffer from endometriosis. At present there is no known cure for endometriosis and the diagnosis becomes laparoscopically. It is noteworthy that once you start experiencing the first symptoms, it takes an average of 8.5 years until the full diagnosis.

Adenomyosis is a pathological condition where endometrial tissue penetrates the wall of the uterus. It occurs in women of reproductive age and is a benign disease. Sometimes there are symptoms such as pain in the period (dysmenorrhea), increase blood flow during period and also increased uterine size. Various theories have been put forward regarding adenomyosis such as genetic factors associated with the uterine development of the fetus during the first months of pregnancy.

Others consider the breakage of the layer between the endometrium and myometrium during surgery allows penetration of endometrial cells in the myometrium. Recently the cutting-edge technology of 3D ultrasound and MRI allows us to confirm the existence of adenomyosis.

The above painless imaging methods in combination with histopathology help us categorize adenomyosis into 2 categories: the focal with an organized benign tumor appearance (adenomyoma) and the diffuse.

Women with adenomyosis tend to show an increased rate of infertility and miscarriages compared with women of the same age and same reproductive profiles in general. This is due to alterations of the microenvironment of the womb which is no more receptive to embryo implantation. Regarding miscarriages, they are mainly related to changing hormonal factors and disturbed microcirculation of the endometrial cavity.

Thus, the fertility specialist should highlight the existence of adenomyvosis of the infertile couple and formulate an appropriate strategy in order to achieve pregnancy in the shortest possible time.

The approach may be pharmaceutical, surgical – laparoscopic or even just waiting, i.e. in the case of a young infertile couple without other coexisting factors, waiting and monitoring could possibly bring the desired results.

The existence of adenomyosis coexists in the majority of cases with endometriosis. Both endometriosis and adenomyosis still remain a medical riddle about their pathophysiological mechanism and have not been fully elucidated. Manipulations of infertile couples should be meticulous since we aim at obtaining the best possible result.

In cases in which there is a problem with the cycle of the woman or weak male factor, the sperm can be enhanced in the laboratory and the ovaries stimulated with oral medications or injections. The monitoring is carried out with ultrasound and blood tests and the insemination is totally painless.

TESE involves making a small incision in the testis and examining the tubules for the presence of sperm. It is either done as a scheduled procedure or is coordinated with their female partner’s egg retrieval.

TESE is usually performed in the operating room with sedation, but can be performed in the or with local anesthesia alone. Testicular tissue is then checked under the microscope for the presence of sperm.

Patients usually cryopreserve sperm during this procedure for future IVF/ICSI.

TESA is a procedure performed for men who are having sperm retrieved for IVF/ICSI. It is done with local anesthesia in the operating room or office and is coordinated with their female partner’s egg retrieval. A needle is inserted in the testicle and tissue/sperm are aspirated. TESA is performed for men with obstructive azoospermia (s/p vasectomy). Occasionally, TESA doesn’t provide enough tissue/sperm and an open testis biopsy is needed.