Ovulation and Endometrioma

[usmcwife10]

Hi, I am 32 and have a 15 yr old and 12 yr old.  I have had a 7cm endometrioma removed in May along with almost all of my left ovary and a lot of lesions (stage 3 endo).  It now does not ovulate, went for an MRI this week and there is a 2cm cyst on my right ovary.  The new Dr. not the one that did the surgery suggested checking it again in late Nov.  She said it looked hemmorhagic (which was what my previous two endometriomas were called when they were small), so I know this is another endometrioma.  My concern is we still want to have a child...will my ovary ovulate with an endometrioma on it?  Also, since this is my last ovary, at what size will the endometrioma be too big to theoretically save the ovary?  I really don't want to lose this ovary, but my endometriomas grow very fast.  Lastly, I get cyst like blemish on my face everytime an endometrioma grows, is that because of the hormones?

[Elaine Brown, MD]

Hi!
If you were my patient, I would do the same thing your doctor is doing.  Wait 6 weeks or so, and re-ultrasound.  The LAST thing you want is another surgery, because each time they operate, more scar tissue will form and that increases your risk of infertility.
If you were my patient, I would suggest either one of two things:
Get pregnant right away!  OR
IF that is not a good option due to timing/finances/ etc.  I would put you on something to suppress cyst and endometriosis formation.  The cheapest easiest way to do that is with birth control pills.  Another option that is pricey but effective is depot lupron.
It DOES sound like you have a rather aggressive case of endometriosis, and you will probably lose your uterus and other ovary eventually.  (Maybe you will be luckier than most--I hope so!).  So, you should use that "equipment" ASAP or keep it in good working order with some type of medication!
By the way, oral contraceptives also work well to reduce acne.
Good luck!
Dr B

[Abbey757]

I was diagnosed with endometriosis when I was 19.  I am now 36.  I have had 5 surgeries but, never allowed the removal of ovaries so that I could try to have a baby.  You will ovulate with endometriomas on your ovary, although it may cause pain.  I am currently going through IVF, although I have been told my one doctor that there is no way to get to my eggs due to 3 endometriomas and a cyst on my left ovary and my ovaries are adhesed to my uterine wall.  With only 1 endometrioma and depending upon the severity or lack of adhesions, seems to me that you would have a good chance to alteast retrieve eggs for IVF.  I have never experienced the blemish on my face.

[usmcwife10]

Hi thank you for replying!  Actually I did try IVF in June the month after my surgery to remove the last endometrioma (before this new one) and removal of adhesions.  I had to have the surgery first, because they wouldn't do the IVF with it there.  We are in Italy and our options are slim as far as REs go.  Alas, the IVF didn't work, they retrieved 5 eggs from my right ovary (which was cyst free at the time) my left did not produce, but is barely an ovary anyways so that wasn't a surprise.  They tried to fertilize the eggs but they just weren't mature enough so it was a failure.  I guess I could try it again, just so scared of more failure and more cysts occurring.  Thanks for your assistance!

[usmcwife10]

Thank you for the reply, I had one question about getting pregnant, can I get pregant naturally with ovary that has an endometrioma?  Or is IVF my only option or maybe IUI?  Thanks!!