Treatment of endometrioma for fertility

[DancingPanda]

I’m looking to hear peoples’ experience of the treatment of endometriomas. I’ve been TTC for approaching a year and a half now and I only found out I might have endo a few months ago (I have a 4cm suspected endometrioma which showed on ultrasound). My consultant is putting me on the waiting list for a laparoscopy and HSG but this is likely to be next year due to Covid. When I asked how she would treat the cyst she said she would essentially burn it. Has anyone has this and gone on to successfully fall pregnant? I’m confused as to the correct treatment and I don’t want anything to be done which could cause further damage. Thanks!

[butterfliez]

Hi I was diagnosed with endo this time last year , was having ivf treatment anyway due to other issues when a large cyst showed up on one of my scans , I was then referred back to gynaecologist, they did a laparoscopy & found a 10cm endometrioma & diagnosed me with endometriosis, they drained the cyst at this time ,

I went back to my ivf clinic 6 weeks later for another scan which showed the cyst had returned but only 4cm this time.

We agreed we don’t want to take the risk of laparoscopy again as it can affect egg quantity/ quality when messing about with ovaries. I am awaiting second cycle to begin. They did put me on Prostap injections to try to shrink the cyst & halt the endometriosis , it hasn’t but it hasn’t got bigger which is a good sign.

They cyst becomes more of an issue if going through ivf because they can only collect eggs from the one side.

I am yet to be pregnant.

They will want you to have laparoscopy to get your diagnosis, depending on where the Endo is for you it may not affect your ability to conceive naturally , they told me I had patches on both ovaries causing the cysts but nothing in my tubes so it wouldn’t have affected conception , I am yet to become pregnant .

Whatever you decide to do it is good to have a diagnosis , I never really had many symptoms so I would not have known. Apparently getting pregnant halts endometriosis growth too.

Covid has affected everything but Hopefully you won’t be waiting too long x

[DancingPanda in reply to butterfliez]

Thanks for your reply, sorry I’m only just seeing them now!

I’m definitely going ahead with the surgery for official diagnosis, although my symptoms and ultrasound make me pretty certain I have it. It’s all a little nerve wracking having surgery, especially on your reproductive organs, but I guess it has to be done! Good luck on your journey to falling pregnant, I really hope it happens for you soon x

[Marmite83]

I have pcos and endo. We had been ttc for 18 months (having suffered a miscarriage after the first 9 months of trying) when I got my suspected endo diagnosis due to a 5cm endometrioma in my right ovary. I was referred for surgery but the next week discovered I was pregnant with my now 4 year old. 18 months after she was born we started ttc number 2. After 6 months of trying I was referred for surgery again as I had an endometrioma on each ovary. One endometrioma was excised. The other one drained itself, when the ovary was released from my pelvic bone, so the consultant cauterised it. He also removed quite a lot of endo from my tubes and said the muscles in my tubes were quite weak as a result of the endo. We continued ttc following surgery but after another 18 months of ttc we decided to go down the IVF route. The consultant could see that the endometrioma on my right ovary (the one that had been drained) had come back. We conceived from our first cycle but it unfortunately ended in miscarriage. Luckily for us, we then conceived again following a frozen transfer and she is now 4 months old. My egg reserve was lowered by the surgery by about a third I think. I believe my tubes were the reason I was struggling to fall pregnant. Unfortunately there's no way to know if your tubes are blocked without surgery. I guess what I'm trying to say is I managed one successful pregnancy with an endometrioma present in one ovary so don't give up hope. The surgery didn't work for us but knowing the extent of the endo, enabled us to make the decision to go ahead with ivf so I don't regret having the surgery. I hope you get your happy ending, good luck!

[DancingPanda in reply to Marmite83]

Thanks so much for your reply, I’ve just noticed it now! So glad to hear you were able to go on and have your 2 babies. I’m going ahead with the surgery, just a little nervous about damage to my ovary but I guess the endometrioma has likely caused damage anyway x

[Jac915]

I had a 3-4cm endometrioma on both ovaries and also done a laparoscopy ovarian cystectomy and excision. My gyne consultant said it will increase my chance of TTC. At the time, I had tried to research (google) for it but no definitive answer. I remember some guidelines recommend removal of a big cyst.

Unfortunately I didn't conceive naturally, I had to do IVF, which was successful. My hubby sperm count was borderline, not sure if it is related though

When I asked my RE, (infertility specialists) when I started IVF, whether the excision was a right decision, she said she hadn't seen my cyst and it was what it was, we should move forward.

If your main concern is TTC, I would suggest getting a RE perspective on you and your partner as well.

One thing to mention, the lap did free me from period pain, I have never known life was so good. But unfortunately endo and pain slowly creeped back after a year.

[DancingPanda in reply to Jac915]

Thanks for replying. The consultant I’m having surgery with is my infertility consultant, I think the only reason she is even going to do the lap is because we are struggling to conceive, she didn’t seem concerned by the cyst or potential endo in other areas, which made me a little concerned. Everything is okay on my husbands side so hopefully it provides us with some answers. Glad to hear your IVF round was successful.

[Afrohair]

Just think wisely before surgery a lot of doctors tell you the positives and not negatives they are always risks with surgery draining can cause reoccurrence excision can damage the ovary slightly and reduce egg reserve it's not overly necessary for someone to say yes you have endo you know your own body!if you think you have endo you most likely have !you don't need surgery to check your tubes I believe they do a dye test all the best !

[DancingPanda in reply to Afrohair]

Thanks for your reply. I will definitely be considering pros and cons to surgery before going ahead.

[wanwood]

I had a large cyst (8 or 9 cm) excised rather than drained. I was told I could either start IVF at that point or have more surgery to remove (excise) the remaining adhesions and endo they couldn’t get the first time and to retrieve the other ovary which was stuck the uterus. In the end we decided surgery would do more good than harm and went for it. I think it was the right decision but who can say for sure? When we did IVF it was successful.

[DancingPanda in reply to wanwood]

So glad to hear IVF was successful for you. Thanks for your reply

[TennisAM]

Hey, it sounds like there's quite a long wait for the op (not surprising) so worth trying other things while you wait. There's N-acetyl Cysteine which is clinically proven to reduce endometriomas. Others have had good experiences from taking serrapeptase for endometriomas and also know of endometriomas being reduced/controlled by chinese medicine.

I haven't had an endometrioma myself but I was told by an endometriosis specialist the ovary should not be burnt (ablation) as this affects fertility. I had endometriosis on my ovary and it was left there to protect my fertility. So worth seeking another opinion from an endometriosis specialist consultant. Are you in the UK? You can be asked to be referred to another endo specialist for a second opinion, you can ask your GP to specify which specialist at a hospital of your choice on the form.

Is your consultant at a bsge endometriosis centre?

Feel free to send a private message regarding the alternative treatments. Happy to share more info x

[DancingPanda in reply to TennisAM]

Thanks for replying, sorry I’m only seeing it now. Unfortunately I’m in Scotland and our treatment pathway is slightly different to others in the UK and it’s not as easy to be seen by an endo specialist. But thank you for the recommendations.