Brief Answer:
Good chances

Detailed Answer:
Dear XXXXXXX

Nice to meet you again on HCM forum.

After your new query, I have gone again through your complete history with all our previous communication, in details.

I have seen your attached report with this query. However, it is the same report of 10 February, 2016 you had uploaded previously. Would you please upload post surgical scan report?

I now understand that you got your ovarian cyst removed. Good. How was it removed? Was it removed by Laparoscopy or by opening the abdomen? Or was is just aspirated?

Whenever we have an opportunity to enter in the abdominal cavity of a woman who is aspiring for pregnancy, we usually test the tubal patency. So if you were subjected to Laparoscopy or Laparotomy, your tubes must have been tested for patency. Would you please inform me the inference?

Further more, was the removed cyst subjected to histopathology study? Usually we do so. Would you please upload the report of histopathology of the cyst?

If your tubes have been reported to be patent, you have all the factors within normal limits. So what you have to practise is try to utilise each and every egg that has been released by the ovaries. I shall repeat again, monitor the ovulation by ultrasonography scan. The egg released when the follicle is between 18 mm to 21 mm has best results of fertilization and continuation of pregnancy. Endometrial thickness also is a key factor. Endometrium of 9 mm to 13 mm thickness is most conducive for the implantation of the fertilized ovum. Your endometrium is reported to be 8.5 mm in thickness, which is not bad. However, if your Gynaecologist can work up on building up endometrium some what more by some oestrogenic preparations (now special medicines for building up endometrium also are available), your chances of pregnancy increase. So try to have maximum sexual relations from the day when the follicle is 18 mm and endometrium about 9+ mm in thickness and onwards.

Since all your hormonal levels are within normal limits, there is an evidence that you are ovulating naturally, your tubes are patent, semen count is within normal limits, you do stand a good chance for natural conception.

How long to give trial for natural conception should be determined by the total number of follicles left in your ovaries. This also can be estimated by MSH estimation. You may request your Gynaecologist for this estimation. If the remaining follicles are very low (which should be expected post 40 years of age), you may give natural trial for not more than 3 months and then may opt for Artificial Reproductory Techniques like intrauterine insemination, in vitro fertilization and embryo transfer, ICSI, etc.

Of course, please get confirmation from the Gynaecologist (who removed your ovarian cyst) about the result of tubal patency test and the information about the histopathology of the excised cyst.

For any, more information or advice, I am always available for you, XXXXXXX Since this is the third time you have opted to ask me your medical queries, I feel you should be satisfied with our discussion. So how about posting a good review with 5 star rating for me? :)

I am expecting the required reports soon.

Dr. Nishikant Shrotri

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Brief Answer:
How was the cyst removed?

Detailed Answer:
Dear XXXXXXX

However, my question regarding the procedure remains unanswered. How was the cyst removed?

Would you mind contacting your doctor again and get the details I have asked for in my previous communication? Particularly:
1. Approach to and mode of the cyst removal
2. Tubal testing performed or not
3. Sent for histopathology study or not

I shall feel more comfortable in guiding you further if you provide me this information.

Dr. Nishikant Shrotri

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Brief Answer:
Follow my instructions in todays first communication

Detailed Answer:
Dear XXXXXXX

Sorry for misinterpreting your narration. :(

If the cyst on the ovary has just disappeared, it might have been the corpus luteum cyst. I had suspected it to be so. In that case, your chances of natural conception are very high provided your tubes are patent. In order to have early success, please follow the instructions in my previous communication; i.e. follow up with ovulation monitoring, finding out ovarian reserve, etc.

I would not hesitate again advising you to assess the tubal patency.

Please feel free to ask me for any more information or clarification.

Dr. Nishikant Shrotri

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