Bilateral Endometrioma conceived through IVF-ICSI - Dr Pinky Shah

Bilateral Endometrioma conceived through IVF-ICSI - Dr Pinky Shah

A 35-year-old female, married for 5 years, visited Dr. Pinky Shah, IVF & Fertility Specialist at Nova IVF, Mira Road. She was a known case of endometriosis and was diagnosed with primary infertility. She also had a history of laparoscopic endometriotic cyst excision in the right ovary 3 years ago.

She also had undergone two cycles of superovulation with IUI (Intrauterine Insemination) as her husband’s semen analysis was normal and bilateral fallopian tubes were patent on Laparoscopy. Concerned that nothing worked the couple visited Dr. Pinky Shah and was looking for a positive outcome through their fertility treatment here at Nova IVF.

What is an Endometrioma?

Dr. Pinky Shah’s patient was suffering from endometrioma, also called a chocolate cyst. It is a fluid-filled sac or pouch that grows on the ovary. These cysts are called ‘chocolate’ cysts because these cysts often contain old menstrual blood that fills the cavity. When these cysts occur on one ovary, it is called unilateral endometrioma, and bilateral endometrioma if they are found on both ovaries.

Symptoms of Endometrioma

The symptoms of endometrioma, unilateral or bilateral, are common to symptoms experienced during endometriosis. These include:

  • Painful periods with severe cramps

  • Pain in the pelvic region not related to periods

  • Irregular periods

  • Painful sex

  • Infertility (in some women)

The size of the cyst is not related to the severity of symptoms experienced by the woman. An endometrioma needs to be treated, but a ruptured endometrioma is an emergency that requires immediate medical attention.

Diagnosis of Endometrioma

On hearing the symptoms and medical history of the patient, Dr. Pinky Shah suspected that the patient’s endometrioma might have relapsed. To confirm this, she performed a pelvic ultrasound on the patient.

The findings suggested that the patient had bilateral endometrioma 3x3 cm in her right ovary and 4x 4.5 cm endometrioma in her left ovary. The antral follicle count was 4 in the right ovary and 5 in the left ovary. Since the couple was undergoing counseling for low ovarian reserve, Dr. Pinky advised the patient to get an AMH (Anti Mullerian Hormone) test. The AMH hormone levels were 0.87. The couple was keen on using the woman’s eggs to conceive.

Due to the patient’s history, a needle biopsy of the cyst was not needed in this case. Both ovaries were accessible on transvaginal ultrasound and thus it helped to anticipate that there will be not much difficulty in accessing follicles while oocyte retrieval.

Treatment of Bilateral Endometrioma

The treatment of an endometrioma depends on many factors such as

  • Age of the female

  • Symptoms, whether it is unilateral or bilateral

  • Whether the patient and her partner wish to have children in the future

Since the ovarian reserves were already compromised in the patient and the couple wanted to have kids using the woman’s eggs, Dr.Pinky Shah decided to avoid surgery to prevent further reducing the woman’s egg reserve. Couples were counselled about success, impact of endometriosis on fertility, AMH value and ovarian reserve.

Dr. Pinky planned to proceed with 2 IVF- ICSI cycles with embryo pooling. Both cycle’s antagonist protocol and dual trigger were given, and the embryos were frozen at day 3 in each cycle. In the first cycle, 3 embryos were formed by day 3, and in the second cycle, 3 embryos were formed by day 3. Dr Pinky Shah gave the patient 2 cycles of injection Lupride depot to suppress her endometriosis.

The Frozen Embryo Transfer (FET) cycle for the patient was planned. All embryos were thawed and transferred to the blastocyst culture. 2 blastocysts were transferred, and no surplus embryos were left. The patient’s Beta HCG (BHCG) level 12 days post-embryo transfer was 707.

A clinical singleton pregnancy was documented, and the patient is currently at 14 weeks of pregnancy.

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