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Thread: Recurring Endometriomas

  1. #1
    Join Date
    Nov 2010

    Default Recurring Endometriomas

    I had a lap in April to remove 10 cm and 5 cm endometriomas on both ovaries also dr. removed adhesions as the ovaries were stick to the uterus and the fallopian tubes, also HSG done and i have one blocked tube as per the lap report
    I tried 2 cycles of clomid and Injections but BFN and one cycle of Femara but also nothing
    All my hormone tests are good as per many doctors, and my husband's semen analysis is great too
    I am 33 now and ttc but last month on my regular monthly check dr. found out one large endometrioma grew back 6cm i was shocked we were heading for IVF but with the cyst that size we are threatened by failure and because as you know of the high cost of the IVF and the associated meds and horemone tests we need to control the cyst before the IVF
    Dr. put me on primolut for one month and asked me to come next month to recheck if the cyst is growing or not shrinking we will do another lap to get rid of it and then move directly to IVF next cycle

    I need you to help me with the right decision and if there is anything else to do or that my dr is making th e right decision

    Thanks in advance

  2. #2
    Join Date
    Oct 2008


    I hope it's not an endometrioma but if it is I recommend you aspirate them rather that cut through the ovaries again. See below:

    In the era of assisted reproductive technology (ART), there are two reasons for the treatment of endometriosis. The first is to alleviate symptoms of pain. The second is in preparation for In Vitro Fertilization (IVF). Conventional surgical treatment of ovarian endometriosis involves either an abdominal incision or laparoscopic drainage of the cyst contents with subsequent removal of the cyst wall. Unfortunately, in many cases, normal ovarian tissue is inadvertently removed along with the cyst wall, which may decrease the number of available oocytes for subsequent fertility treatment. A large percentage of such women have advanced stage disease and have had multiple previous surgeries. In the presence of pelvic adhesions, visualization of anatomic structures may be inadequate, leading to inadequate surgical removal with frequent cyst recurrence, which could further diminish the potential response to ovarian stimulation with gonadotropins. In addition, most women with advanced endometriosis (ie; those who are also more likely to have endometriomas) are likely to have developed pelvic adhesions and accordingly are at increased risk of surgical complications. Many patients with recurrent ovarian endometriomas are uncomfortable with the prospect of repeat surgery and its avoidance is often a factor in the decision to proceed with IVF. There have been several reports on the use of sclerotherapy in the treatment of recurrent ovarian endometriomas. We have experience with the use of sclerotherapy in many women with endometriomas, who were preparing for treatment with IVF.

    Sclerotherapy for ovarian endometriomas involves; needle aspiration of the liquid content of the endometriotic cyst, followed by the injection of 4-5% tetracycline into the cyst cavity. Treatment results in disappearance of the lesion within 6-8 weeks, in more than 75% of cases so treated. Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia. It has the advantage of being an ambulatory office- based procedure, at low cost, with a low incidence of significant post-procedural pain or complications and the avoidance of the need for laparoscopy or laparotomy.

    Sclerotherapy is a safe and effective alternative to surgery for definitive treatment of recurrent ovarian endometriomas in a select group of patients planning to undergo IVF. Since the procedure is associated wit a small, but yet realistic possibility of adhesion formation; it should only be used in cases where IVF is the only treatment available to the patient. Women who intend to try and conceive through fertilization in their fallopian tubes (e.g; following natural conception or intrauterine insemination) will be better off undergoing laparotomy or laparoscopy for the treatment of endometriomas.

    Recommended Reading

    1. Aboulghar MA, Mansour RT, Serour GI, Sattar M, Ramzy AM, Amin YM. Treatment of recurrent chocolate cysts by transvaginal aspiration and tetracycline sclerotherapy. J Assist Reprod Genet 1993;10:531-3.

    2. Chang CC, Lee HF, Tsai HD, Lo HY. Sclerotherapy—an adjuvant therapy to endometriosis. Int J Gynaecol Obstet 1997;59:31-4.

  3. #3
    Join Date
    Nov 2010


    Thank you dr. walid for your reply, another dr recommended to me this buthe was talking about something like suction of the endometriomas but didnt mention about the solution injected after that, may be its the same procedure but i just misunderstood
    but do you believe me if i told you that the exact DR. who did this study "M. Abol Ghar" never mentioned it to me i visited his private clinic to consult him for my IVF all he said is forget about your endometriosis and go directly for ICSI or try clomid and if it didnt work then ICSI

    anyway thank you for your reply i think i'll do what you recommended also recommended by another doctor

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