Diminished Ovarian Reserve...and cyst

I have had a 2.9 ovarian cyst on my left ovary for well over a year. It was discovered during my u/s for chlomid.  My CA 125 levels were elevated (54) but my oncologist said I could go ahead with fertility support.  A fertility specialist did an u/s and said my right ovary looks like it is aged.  I have one child so he has left the option of laparoscopic surgery up to me.  He believes there may be endometriosis on my left ovary - I had an hsg and all is normal. He said if I had not conceived previously he would immediately do laparoscopic surgery but because I have gotten pregnant in the past the decision is up to me.  My options are laparoscopic surgery or go ahead with injectables.  Any thoughts??  I appreaciate all your help!

[Forum-M.D.-SP]

Sure - I think you have two choices, neither one necessarily worse or better than the other.

Your choices, in my opinion, are:

1) Have the laparoscopy for excision of the cyst

or

2) injections with inseminations, moving to IVF if injections and inseminations do not work.

The scientific literature on the topic suggests that surgery for endometriosis (if this is what it turns out to be) involving an ovarian endmetrioma (an ovarian cyst caused by endometriosis) helps to improve the chances of getting pregnant on your own.

My feeling is that injectables and IUI will be more likely to succeed if you have laparoscopic surgery first, but there is less data in the literature to confirm this.

However surgery does not seem to improve the chances of success with IVF - chances for successful IVF seem to be just as good whether or not you have surgery first.

No right or wrong answer. Hope this helps.

[SM247]

Hi!  It's wonderful that you have one child already!  I don't know much about our women parts, but I do know a little about endometriosis!  I had a laporoscopy Dec 1998.  They originally went in to remove a HUGE cyst from my right ovary that was the size of a 16 in softball.  When they went in, they discovered I had endometriosis.  So they burned/lasered the majority of that off and the cyst was removed.  I was put on Lupron injections to supress my women parts, and then was told to have babies ASAP!  HAHA!  I was 19 yrs. old, so, all in all, a laporoscopy is such a common thing, it's a cleaning for your women areas.  They scope out anything abnormal and make sure you are diagnosed correctly!  Go for it!  It can't hurt!  My aunt had it done b/c they were trying to figure out why she wasn't getting pregnant.  They cleaned her out a bit and then 2 months later, she was prego!  I hope I have helped you out somewhat!  

[vidflorida]

Thanks for your help! I am waiting to hear some more results from my endocrinologist and will have my FSH levels tested next cycle.  My gut says why not laparscopic surgery...especially if it is endometriosis.  Just wondering why the doctor's aren't more aggressive with the idea. Is there a risk I am missing or another reason why they would want to jump into injectables???Have a happy New Year!!

[SM247]

I am sorry I haven't gotten back to you, I am really new to this site!  Anyway, most doctors are conservative, as you know!  But, due to INSURANCE purposes, they have protocols to follow!  You are at the age where if you have tried conceiving for 6 months, you can go further into treatment!  Check into that!  How are you now!  Laproscopic surgery is super easy and fast!  It's outpatient and the recovery isn't harsh!  Mine was a different story, but usually, it's quick recovery!  Ask lots of questions, don't be scared!  1 million questions and more....never wait for anyone!  Some doctors are just really old school!

SM247

[SM247]

I am sorry I haven't gotten back to you, I am really new to this site!  Anyway, most doctors are conservative, as you know!  But, due to INSURANCE purposes, they have protocols to follow!  You are at the age where if you have tried conceiving for 6 months, you can go further into treatment!  Check into that!  How are you now!  Laproscopic surgery is super easy and fast!  It's outpatient and the recovery isn't harsh!  Mine was a different story, but usually, it's quick recovery!  Ask lots of questions, don't be scared!  1 million questions and more....never wait for anyone!  Some doctors are just really old school!

SM247