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Surgery

Surgery is a clinical decision, not a default. Before any procedure is recommended, we conduct a thorough evaluation to understand exactly what is contributing to your fertility challenge. If surgery is indicated, you will know why, what it involves, and what comes next. If it is not indicated, we will tell you that too.

If you have been through multiple cycles, or lived with pain that has been dismissed, or suspected that something structural was never properly looked for, you are not imagining it. Reproductive surgical conditions are real, they are diagnosable, and when they are present, they can often be treated. Our approach starts with finding out what is actually there.

Services

Everything You Need, All in One Place

Surgery Providers

These board-certified specialists practice at Upper West Side and coordinate your care across all our locations when needed.

George D. Kofinas, MD, FACOG

Reproductive Endocrinologist

As the compassionate leader of Kofinas Fertility Group and a distinguished authority on fertility medicine, Dr. Kofinas has used his depth of knowledge and sharp intuition to help thousands of couples start families of their own. Dr. Kofinas has written and spoken about the full spectrum of assisted reproductive technologies, such as reproductive surgery and in vitro fertilization (IVF), and he has personally trained every doctor on his staff.

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Jason Kofinas, MD, MSc, FACOG

Reproductive Endocrinologist

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Peter Brzechffa, MD, FACOG

Reproductive Endocrinologist

Peter Brzechffa (BRESH – fuh), MD, FACOG is an active family man and the associate director of Kofinas Fertility Group in New York. Interpersonal connection is a big deal for Dr. Brzechffa, and even after over 20 years in fertility care, he still cherishes every minute that he spends with the people he treats.

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Melissa Montes, MD, MSc, FACOG

OB/GYN Specialist & Minimally Invasive Gynecologic Surgeon

Melissa Montes, MD, MSc, FACOG has over 10 years of experience helping New Yorkers and beyond start families. With numerous peer-reviewed publications and thousands of success stories under her belt, she continues to help Kofinas Fertility Group advance the boundaries of fertility medicine.

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Levica Narine, MD, FACOG

OB/GYN Specialist & Minimally Invasive Gynecologic Surgeon

Levica Narine, MD, FACOG places high value on face-to-face time with those she treats at Kofinas Fertility Group in New York. As an experienced OBGYN, Dr. Narine has solved a wide range of fertility and reproductive problems with many different types of people. Each challenge motivates her to do better, and every experience she has inspires greater passion for her work.

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Heather Toskos, MD

Why did you go into this profession?

Societies have long recognized the importance of family building. As reproductive medicine progressed, so did our understanding of its generational impact on women, their relationships, and their legacies. Today, we can reshape the fertility narrative and help patients take back control of their own biology.

Our therapies and technologies are rapidly changing, and I am proud to contribute to this ongoing evolution. As our understanding of physiology and genetics grows, innovations continue to flourish and take us farther than we were yesterday. From endometriosis treatment to preimplantation genetic testing, the scope of our practice is far reaching with great implications for the future of modern family building.

What did you find compelling about it? What do you most enjoy about it now?

I am proud to advocate for women’s health, and support patients in improving their quality of life and reaching their family goals. At our practice, we are pushing the boundaries of what is possible, and I am excited to see what new therapies we will offer our patients in the coming years.

How would you characterize your style of patient interaction?

Every patient has a story of their journey, and that story can be rewritten. Many journeys are paved with ambiguity, loss and the unknown. My role is to help patients retell their story in a space that is safe, respectful and rooted in trust. I strive for every woman to feel informed about her options and confident that she is receiving a comprehensive plan delivered with skill and compassion.

What do you hope to be able to give or do for patients?

The path to pregnancy can be overwhelming, but I am dedicated to navigating patients every step of the way. My goal is for patients to feel heard, understood, supported, and encouraged. Every woman deserves clear insight into her reproductive health and the opportunity to shape her family vision.

What is your best quality as a member of this practice’s team? How does that help you in your role?

My greatest quality as a member of this team is my commitment to evidence-based care and attention to detail. I stay current with the latest research and continually seek the next based strategies for my patients. Every clinical situation requires meticulous, individualized care, and I make sure to take all aspects into consideration when creating a treatment plan.

My background in minimally invasive surgery allows me to explain how internal disease processes can go unnoticed unless carefully evaluated. Conditions such as endometriosis and fibroids are two of the most common examples that can be surgically treated with significant effects on fertility and chance of live birth. My previous training in obstetrics also helps me to anticipate high risk pregnancy states and work to prevent complications through careful evaluation and optimization of the first trimester.

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Charalampos (Harry) Chatzicharalampous, MD, PhD, FACOG, FACMG

Reproductive Endocrinologist & Clinical Geneticist

Now try saying it 3 times as fast as you can. Just kidding, we call him Dr. C for short.

Dr. C is the newest member of the Kofinas Fertility team and we are thrilled to have his incomparable experience in both Reproductive Endocrinology & Infertility and Medical Genetics (AND delightful personality) at our center. His 14 years of training and expertise were enough to add so much value to our patients, but it is his vibrant and detailed approach to his patient care that sets him apart.

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Frequently Asked Questions

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Get quick answers to frequently asked questions

Surgery is not the starting point. A thorough diagnostic evaluation, including imaging, hormone testing, and in some cases a direct assessment with laparoscopy or hysteroscopy, helps identify whether a structural factor is present. If your evaluation shows a condition such as endometriosis, fibroids, or a uterine anomaly, your clinician will explain whether and how surgery fits into your plan.

Excision means surgically removing endometriosis tissue from its root. Ablation destroys tissue using heat or another energy source but does not remove it. Many reproductive specialists prefer excision for fertility-related endometriosis care, though the best approach depends on the individual case. Your clinician can explain which technique is being recommended and why.

This depends on the type of surgery and the extent of disease. For patients with endometriomas (ovarian cysts caused by endometriosis), surgical removal carries a risk of reducing ovarian reserve, and this needs to be weighed against the potential benefit of the procedure. Your clinician should discuss ovarian reserve testing both before and after surgery when relevant.

Recovery varies by procedure. Many patients return to light activity within a few days to a week after laparoscopy, though more complex surgeries may require longer recovery. Your care team will provide a personalized timeline based on what was done. If IVF is part of your plan, your clinician will guide you on when it is appropriate to begin a cycle after surgery.

This depends on your full clinical picture. Some patients conceive naturally after a surgical issue is addressed. Others may still benefit from IVF, particularly if additional factors such as sperm parameters or egg quality are involved. At Kofinas, the goal is to make sure the path forward reflects your actual diagnosis, not a default assumption.

Hysteroscopy is a procedure in which a thin, lighted scope is passed through the cervix into the uterus to examine the uterine cavity or perform minor treatments such as polyp removal. It is typically performed under anesthesia or sedation, so discomfort during the procedure is minimal. Some patients experience mild cramping afterward.

Myomectomy is specifically designed to remove fibroids while keeping the uterus intact, which is why it is often preferred over other fibroid treatments for patients who wish to conceive. The safety and appropriateness of myomectomy depend on fibroid characteristics and your overall health, which your clinician will review with you.

Timing depends on the type of surgery and the extent of treatment. Your clinician will provide specific guidance based on your case. Rushing into conception too early after certain surgeries is not advisable, as adequate healing time may improve outcomes.

Yes. If you have had prior surgical treatment and are experiencing recurrence or ongoing fertility concerns, a surgical consultation at Kofinas can include a review of your prior records, imaging, and surgical history. This allows for a more informed discussion of your current situation and whether additional evaluation or intervention may be helpful.

Yes. If you have received a recommendation for surgery and want an independent review, a second-opinion consultation is available. Bringing prior records, pathology reports, imaging, and operative notes will help ensure the most informed discussion.