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Doctors Mohsenian and Fahimi are both charter members and active members of the prestigious and exclusive Society of Reproductive Endocrinologists and Infertility Specialists. Some of the specialized reproductive surgery and endocrinology conditions in these domains are described below.
Reversal of Tubal Sterilization (Tubal Reversal)
Women who have had their tubes tied sometimes decide that they want to conceive. Before proceeding with reversal, the doctor will conduct some tests to determine how the tubal reversal would compare to In Vitro Fertilization. Tests may include a semen analysis, X-rays of the tubes and uterus, hormone tests, and a possible laparoscopy. A tubal reversal is performed in the operating room through a 3-4 inch incision with the help of a microscope. The patient is discharged the next day.
Microsurgery
This procedure is almost completely replaced by in vitro fertilization except for tubal reversal. It requires a 3-5 inch long incision with overnight stay at the hospital.
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In 1987, the Infertility and Gynecology Center of Lansing was responsible for the first mid-Michigan baby born through laser surgery for tubal repair. This breakthrough technology was then featured on the Lansing State Journal front page. |
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Laparoscopy, Diagnostic and Operative
Involves a few incisions about 1/4 to 1/2 inch long through which a scope, gas, and surgical instruments are passed into the abdomen. This outpatient procedure has almost completely replaced large abdominal incisions. Most reproductive surgeries can be performed using this technique, requiring minimal recovery time. For example:
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Ultrasonic pelvic surgery. This technology has almost completely replaced laser surgery. This procedure is performed through a laparoscope on an outpatient basis. It is more versatile, user-friendly, and gentler on tissues. A slim ultrasound activated probe is used to wipe out endometriosis, lesions, or adhesions from bowels, bladder and other areas that can be too risky for laser surgery.
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 Laser surgery. It is almost completely replaced by newer surgical technologies such as ultrasonic surgery, plasmakinetic current and newer cautery units, but is still occasionally used.
- Conservative reconstructive pelvic surgery is used for ovarian cyst, fibroids, endometriosis, damaged tubes, and
 adhesiolysis.
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Hysteroscopy, Diagnostic and Operative
This technique is used to visualize the inside of the uterus and does not require an incision. A scope is passed through the cervix into the uterus and either a gas or a fluid is used to expand the cavity. Various procedures may then be performed through the hysteroscope. For example:
- Hysteroscopic removal of polyps.
- Repair of uterine septum and congenital anomalies of uterus.
- Removal of fibroid.
- Removal of intra uterine adhesions and scars.
Myomectomy
This refers to removal of fibroid tumors from the uterus without removing the uterus. This can be accomplished either through a 3-5 inch large incision, through a laparoscope or a hysteroscope, depending on the size, numbers and location of the fibroids.
Endometriosis
This is a genetic condition characterized by the presence of patches of the uterine lining (endometrium) in areas where they do not belong, such as the pelvic walls, ovaries, tubes, etc. Endometriosis can be treated by medication and/or surgery, including laparoscopy, laser surgery and ultrasonic, plasmakinetic or new electrocautery technologies.
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Polycystic Ovarian Syndrome (PCO or PCOS)
 This condition is defined by the presence of at least two of three of the following signs:
- Menstrual irregularities.
- Specific ultrasonic findings on ovaries.
- Evidence of elevated male hormones.
Recent advancements in the understanding of this syndrome and insulin resistance has led to better control of PCOS through the use of anti-diabetic drugs such as Metformin (Glucophage).
 Menstrual Irregularities
Menstrual irregularities, lack of menses, abnormal uterine bleeding (AUB), and progesterone problems can be associated with anatomical, hormonal or ovulation anomalies. Fibroid tumors, polyps, precancerous or cancerous changes in the uterus and hormonal imbalance including thyroid dysfunction could be responsible. This is only a short list of what can cause these problems. A hormonal and anatomical assessment is required.
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Induction of Ovulation
Women who desire to conceive may benefit from induction of ovulation. This is best accomplished through the use of fertility drugs.
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Clomiphene citrate (Clomid, Serophene), an oral fertility drug, has been available for more than 50 years. Ironically, it was originally designed and developed as a contraceptive! Contrary to popular belief, it is not generally associated with a significant increase in high order multiple births.
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Aromatase Enzyme inhibitors (Femara, Arimidex).
These antiestrogenic drugs are primarily used for the medical treatment of breast cancer. They have been used in Europe and some other countries for over a decade as fertility drugs for induction of ovulation as an alternative to Clomiphene Citrate. They are now being used off-label in the United States for that purpose. These drugs are also being investigated for medical treatment of endometriosis and fibroids.
- Superovulation is accomplished through the use of injectable fertility drugs.
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