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Thread: Endometriiomas and laparoscopic surgical options

  1. #1
    Join Date
    Mar 2009
    Posts
    7

    Default Endometriiomas and laparoscopic surgical options

    Hi Dr. Walid

    I am 32 years old woman, with bilateral ovarian cysts most propably endometriomas. The one on the right is small (2 cm), and single, and the one on the left are mutiple and some of them are large (3 cm). I had difficulty in getting pregnant, with 5 years TTC, two chemical pregnancies and one abortion at 3 moths. I had regular cycle and good ovulation.

    I underwent a laparoscopic suregry for my endometriomas one week ago. The doctor has performed a drainage and coagulation approach for the cysts because he said he did not want to lower my ovarian reserve (which were good according to my day three FSH/ estradiol). After the surgeries I experienced recurrence of the pain I used to have. After the operation, I read that cystectomy would have been a better approach for me because thay have better fertility rates and less recurrenc, but I have known this too late. My questions for you:

    1. If I fail to get pregnant after the surgery, can I go under ANOTHER laparoscopy, but this time a cystectomy? Or will that be technically difficult? Can a previous coagulation of ovarian endometrioma make cystectomy difficult, or more hazardous (like leading to ovarian failure)

    2. Now that I have already gone a laproscopic drainage and coagulation of the cyst, do I still have good chance of getting pregnant in the light of previous information?

    3. Was it a wrong decision choosing this doctor? I had another doctoctor recommending cystectomy for me, but I was hesitated to choose him because he was less experienced, now I feel really guilty and sad for making the wrong decision that may further comprise my chances of getting pregant, should I feel that way?

    Thanks a lot for your help, and sorry for the long post.

    Heba

  2. #2
    Join Date
    Oct 2008
    Posts
    387

    Default

    1. If I fail to get pregnant after the surgery, can I go under ANOTHER laparoscopy, but this time a cystectomy? Or will that be technically difficult? Can a previous coagulation of ovarian endometrioma make cystectomy difficult, or more hazardous (like leading to ovarian failure)

    A: Ovarian failure or decreased ovarian reserve (DOR) unlikely after one cystectomy. Unfortunately coagulation does nothing as endo is a microscopic disease and persists. All these surgeries are palliative not curative. I would only operate for pain control. The surgeries do not improve conception rate.


    2. Now that I have already gone a laproscopic drainage and coagulation of the cyst, do I still have good chance of getting pregnant in the light of previous information?

    A: Same as before. I advise you move to IVF sooner rather than later. So that, if multiple surgeries are needed for pain, you do not end up with DOR.


    3. Was it a wrong decision choosing this doctor? I had another doctoctor recommending cystectomy for me, but I was hesitated to choose him because he was less experienced, now I feel really guilty and sad for making the wrong decision that may further comprise my chances of getting pregant, should I feel that way?

    A: no major difference in both approach. The key is to undergo IVF and freeze extra embryos before you end up with DOR. You also need to be tested for NK activity as this issue occurs more frequently with endo and increases the rate of m/c. Hope that helps.

  3. #3
    Join Date
    Oct 2008
    Posts
    387

    Default

    This is not a medical advice

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