Hi XXXXXX XXXXXXX

Thanks for your question. My name is Dr Omer and I am here to help you today with your question. I will be happy to assist you with your follow up questions also. I am sorry to hear about your problem.

First of all congratulations on your upcoming marriage.

As you have said your MRI clearly shows that you are having polycystic ovarian syndrome (Para with normal appearing ovaries, with normal vaginal position, nabothian cysts.

Nabothian cysts are considered harmless and usually disappear on their own, although some will persist indefinitely. Some women notice they appear and disappear in relation to their menstrual cycle, it can also cause infertility , so do go to gynecologist.

Oligomenorrhea (defined as missing more than four periods per year [i.e., having fewer than eight periods per year], which amounts to >45 days between menstrual periods) or secondary amenorrhea (defined as >90 days without a menstrual period) after initially menstruating is hallmark of PCOD.

Adolescents who have irregular menstrual cycles have higher serum androgens than do those who have regular menstrual cycles. One-third of these patients have androgen levels that are greater than those in normal adults. Once hyperandrogenemia develops during adolescence, it usually persists into adulthood. Thus, a high androgen level in an adolescent with irregular menses strongly suggests a diagnosis of PCOS, even in the absence of other clinical features of the syndrome.

So do check your LH/FSH/Testosterone level for pcod.

Polycystic ovaries are found in about 20 percent of seemingly normal females, but about half of these have subtle ovarian endocrine dysfunction.

Women with PCOS have infrequent ovulation, and therefore take longer to conceive. Many, if not most women who have PCOS and oligoovulation and desire fertility eventually undergo ovulation induction therapies (clomiphene).

Women who have PCOS may have other reasons for infertility as well like hpothyroidism, nabothian cysts in your case.

Now coming to hypothyroidism, for which you are taking thyronorm.
Hypothyroidism itself causes infertility, and difficult to conceive if tsh is>2.5.

SUMMARY.
YOU have 3 causes of infertility.
1.PCOD
2.Hypoothyroidism
3Nabothian cysts( low chance of infertility)

All the above causes are treatable by following and you can easily conceive (98@ chance).
1. for pcod start taking clomiphene when you require to conceive
2.Take thyronorm to get tsh <2.5 to get conceived
3. Go to gynecologist for nabothian cysts

With all above measure, you can get easily conceived (98%)
So please don’t get stressed up , cause stress is another cause of infertility.

I wish you good luck that you get well soon, if you have any question, please ask because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to assist you always.

Take care

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Hi again,

your MRI pelvis is normal except for nabothian gland ,they can be normal as well but get gyanecologist review fluid in pouch of XXXXXXX is normal too, but for cyst next to ovaries can or cannot be normal , so do a ultrasound pelvis for PCOS.

Pelvic ultrasound — The diagnosis of PCOS does not require the presence of polycystic ovaries, as detected by ultrasonography , although 80 to 100 percent of women with the PCOS do have polycystic ovaries on ultrasound, as the presence of eight or more small (2 to 8 mm) follicles in each ovary. However, the polycystic appearance is non-specific, since it can also be seen in women with idiopathic hirsutism, other androgen excess disorders, and even normal women

In women with PCOS, in addition to measurement of serum hCG (human chorionic gonadotropin)to rule out pregnancy, minimal laboratory testing should include measurements of serum prolactin, thyrotropin, and FSH to rule out hyperprolactinemia, thyroid disease, and ovarian failure, respectively.

Approximately 45 percent of women with PCOS have type 2 diabetes.
Given the high prevalence of lipid abnormalities in PCOS, we suggest measuring a fasting lipid profile in all women with the disorder.

The Pouch of XXXXXXX medically known as the recto-uterine pouch is a cavity between the anus and the uterine wall, and occurs only in women. It is the deepest part of the peritoneal cavity and is directly related to a woman's sexual satisfaction. It can often contain a certain amount of fluid. In most cases this is perfectly normal.

A paraovarian cyst is a closed, fluid-filled sac that grows beside or near the ovary but is never attached to them. It is usually located on the broad connection (ligament) between the uterus and the ovary, and is often found on only one side (unilateral) of the uterus. It is thought to develop from embryological vestiges (Wolffian structures).

Paraovarian cysts are usually very small (ranging in size from 2 to 20 cm). These cysts have little clinical significance, occurring asymptomatically as incidental findings during other pelvic examinations and surgeries. Most often, they are diagnosed as benign ovarian cysts or as fluid-filled distention of the fallopian tube (hydrosalpinx).

Although known for their small size, paraovarian cysts can sometimes grow larger, especially during pregnancies. Unlike the small cysts, the larger cysts are usually symptomatic.

Depending on their size and location, large paraovarian cysts can put pressure on the bladder or bowel, and cause pelvic pain or pain during sexual intercourse (dyspareunia).

Larger paraovarian cysts tend to develop in younger women, quite often during a pregnancy, at which time they have a tendency to grow rapidly.

Paraovarian cysts are relatively common and account for 10% of all pelvic masses

NO SURGICAL REMOVAL IS NOT RECOMMENDED AS IT CAN RANGE FROM NORMAL TO PCOS DISEASE.

Take care,

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