ovulation issues - enlarged ovary.. etc

[marcycantrell]

Live in small midwestern town with no fertility experts. Had miscarriage end of june at 6 weeks. Took until end of Aug for HCG levels to fall to 0... first regular period first week of October. I'm almost 40 and trying to conceive third child - never had fertilty issues in past, so this taking so long to get cycles back on track is very difficult. Now after first regular period, ultrasounds shows enlarged follicle or ovarian cyst of 50mm.. so apparently the follicle that was 18-23mm week before period has only gotten larger.  Local doc suggested 1 cycle of birth control but I've read this isn't effective against formed cysts.. So question.. is that normal that took that long for cycle to come back? Can I still ovulate with a cyst this large? How long do cysts take to go away and anyting I can do to speed up the process? Every doc has different opinion and time is ticking. Youngest child born in Feb 08 and am turning 40 at end of year. So this has slowed my attempts to conceive our third.   Blood test week before I got my period early Oct show following levels: TSH 1.25, Estroldol -144, Prolactin - 5.2, FSH - 3.6. Are these levels normal? With no fertility experts around, I feel lost in this race against clock to conceive.  What should I do.. what do results mean on my bloodwork..what treatment on cyst and mainly.. when can I tell when I can start trying to conceive?  Finally does past fertility suggest I should be fine and not to worry quite so much?

[Elaine Brown, MD]

Hi!
Your FSH and your past fertility history BOTH portend good things.  So, since worrying will only harm you, I would suggest not doing it, or at least keeping it to a minimum.
You are correct that oral contraceptives are effective in preventing new cysts but don't do much for cysts that have already developed.  It depends upon what the cyst is how long it will take to resolve.  If it is a hemorrhagic corpus luteum cyst, it should be gone within 4-6 weeks.  If it is a dermoid/mucinous cyst/serous cyst, etc. it won't go away at all.  It also won't prevent conception if it is that type of cyst. In terms of fertility, it is always preferable to avoid surgery for fear of scar tissue developing near the tubes.  If the cyst continues to enlarge though, you may have no other option.
If you were my patient, I would recommend that you have a follow up ultrasound in 4-6 weeks.  In the meantime, I suggest that you do ovulation predictors to see if you are going to ovulate this cycle.  A mid-cycle ultrasound would be helpful too--to see how many follicles are developing and also to get an antral follicle count.  (this is another measure of your residual fertility).  The biggest problem for women over 35 is not necessarily that they don't have eggs, just that so many of the eggs are no longer healthy.  (despite a healthy lifestyle--its just wear and tear).  This leads to a high rate of miscarriage and a reduced rate of fertility.
You have a very decent chance of conceiving without ART but, don't wait a super long time before seeing a specialist if things are not happening.
I hope all goes well for you!
Good luck!
Dr B

[trying_hard_for_number_three]

Hi Marcy:
I also have had large follicle cysts (and also have had 2 "easy" pregnancies).  We are also trying for our third and jumping through hoops to get one (or two  :).
My dr. puts me on a month of Yaz when I get these cysts, and they go away in that month.  I HATE Yaz, but he says that you need the strong hormones and not all birth controls have that strong of hormones.  It has been working on the months when I need it, but it does slow up the process.  Having the cyst does impact ovulation and/or follicle production, so it is important to get rid of it.
I THOUGHT that since I had two easy pregnancies, I would have no problems, but it has been a year and a half now...and I am getting worried, too.  This fertility stuff is also quite costly, but we are going to keep on keeping on!
I am not sure about your levels...I can't remember any of mine.
Cysts are frustrating--I am always wondering, "Why now?"
Good luck to you!

[marcycantrell]

Great to hear from someone who knows what this is like.. I paid to get a professional answer this through this website.. but have heard nothing. So I'm a bit confused on how this works.  Do you know? If a doctor answers, you should read their response as well. Sounds like we are in same boat.  I actually just walked in the door from going to my OB-GYN this morning. Doc says 90% of women get these and most don't even realize it. If it doesn't go away by 6 weeks, he recommends having it drained or removed in surgery, depending on what kind it is. You are right, he says you probably won't ovulate with a cyst.  He said the jury is out on whether or not birth control pills have an impact on existing cysts, but he ususally prescribes them.  My gut says if I wasn't trying to conceive, I would let it go away on their own. But to get pregnant, I don't have that time. I will have it drained.  He says to try to conceive for about 4-6 months then after that before going to fertility specialist, although I am going to one anyhow in Mid November. It won't hurt anything - just be time-consuming since I have to drive to another state.  I am fortunate that I have full insurance coverage on this.. or I would not be able to pursue this path.  Keep in touch and let me know how you do. I will consider Yaz as well.