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Reasons for chocolate cyst in the left ovary and infertility issues - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Infertility Problem
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   my wife had a chocolate cyst (right ovary - 5 cm) and it was removed in Sept last. After that she was on lupride for three doses (last on Dec 17). Now she had her first period and she is on her 10th day. The sonography revealed a cyst on the left ovary measuring 6.5 cm. Right ovary is small (no cyst). What could be the reason for appearance of cyst in the left ovary when she was on lupride since the laproscopy and also considering the fact that she was not menstruating all these months
Doctor :   Hi
Doctor :   I am Dr. xxxx
User :   Hi
Doctor :   Let me read the query]
User :   sorry the last dose of lupride was on Nov 17 and not Dec
Doctor :   Ok, right now I guess we are speaking about Endometriosis
User :   yes Dr
Doctor :   The medical science has no robust explanation about the causes of Endometriosis
Doctor :   Some say that instead of normal periods the blood spills in the reverse direction and thus falls on the ovary and the adjoining structures to form chocolate cysts
Doctor :   So it does not mean that any therapeutic procedure is going to be permanent solution
Doctor :   Laparoscopy is just a diagnostic procedure most times
Doctor :   and if there are adhensions ( structure attached one another) it helps to relase them
User :   my doubt is ------
User :   earlier sonography revealed 5 cm cyst on right ovary and a similar lesion of 1.7 cm on left ovary
User :   now the sonography says that right ovary is small (this is a sonography done to see follicular study)
User :   and left has a cyst of 6.5 cm
User :   so does it mean that the earlier lesion of 1.7 cm has grown to 6.5 cm in these 5 months ?
User :   Hi, are you there?
Doctor :   Yes
Doctor :   Is the chocolate cyst or the Follicular cyst?
User :   my wife says that the sonologist told her it appeared to be a chocolate cyst
Doctor :   Ok
User :   i am afraid i dont know what you mean by follicular cyst
Doctor :   Follicular cyst is the ovum growing bigger and to relase by the ovary
Doctor :   Ok, might be the Lupron injection were not successful to suppress the endometriosis
User :   she is 39 years old
User :   can we try for conceiving in this stage
Doctor :   To be honest, the medical treatment has been shown not to be helpful in improving fertility, medical therapy for endometriosis is no longer advised for infertile patients.
Doctor :   Treating endometriosis with medicines has definite limitations. Medication usually controls mild or moderate pain and may eliminate small patches of the chocolate cyst.
Doctor :   Large chocolate cysts (>5 cm) in the ovary are less likely to respond, and drugs cannot remove scar tissue.
Doctor :   This is why surgery may be needed to improve fertility by removing lesions, nodules or endometriomas.
User :   thats ok, but the right ovary cyst (5cm) has been removed earlier and there is no cyst in the right ovary now
User :   so do you mean that surgery is the only option
User :   will this cyst affect ovulation, etc
User :   actually today right ovary measured 11.5 mm (against 5 mm) day before yesterday
Doctor :   yes
Doctor :   Laparoscopy can be used as a therapeutic tool. For example, fluid can be drained ; and patches of endometriosis destroyed using a laser or electrical current.
Doctor :   I suggest for an IUI
User :   i see
User :   can't the right ovary function normally and release an egg into the fallopian tubes
Doctor :   Because 39 yrs the ovaries are not much of quality
Doctor :   so it is good to go for IVF, with good quality egg and then artificial fertilisation
User :   then can we go for ART right away without bothering about the cyst
User :   as we will lose time in the surgery
Doctor :   Yes
Doctor :   Which city are you in
User :   xxxxx
Doctor :   Importantly you have to choose the best technology and experience
User :   can you suggest
Doctor :   WWW.WWWW.WW
User :   we stay in xxxxx
User :   so that will be too far
Doctor :   Ok, you may choose to hurry up as the time is definitely less for you
User :   anyone else you know of in the other suburbs
User :   xxxxxxxxxxxx
Doctor :   I have no readily available information
Doctor :   But I can try to find out
Doctor :   So have you been to Dr. xxxx
User :   no never been there
User :   Dr, please note that we are married only for 11 months, so it is not that we have been trying for years to conceive
User :   its just that we didnt conceive in 4 months, so we consulted gynaec
Doctor :   It is not an issue of marriage now
Doctor :   It is aboiut chocolate cyst and small rt ovary
User :   ok, so do you mean that small right ovary (11.5 mm) and E.T. of 5.8 mm is too less for 10 day of the cycle?
Doctor :   yes
Doctor :   are you with me?
User :   yes Dr I am back
Doctor :   yes
User :   Are you there, Dr xxxxx
Doctor :   Please go ahead
User :   so do you mean that the follicular study so far is not very good?
User :   right ovary was 5 mm on 8th day and today (10th day) it is 11.8 mm
Doctor :   The ovary is growing good but I am not sure whether it is Chocolate cyst?
Doctor :   Luproline is supposed to suppressed the ovulation
User :   no, the sonologist has clearly said that the right ovary is 11.8 mm and there is no cyst
Doctor :   Luproline is a medical management of Endometriosis
User :   the cyst is only on the left ovary
Doctor :   The right ovary is growing at the right pace
Doctor :   In the follicular study As follicles spontaneously reach maturity in the natural cycle their inner dimensions range from 17 to 25 mm
Doctor :   It is important to know the internal echoes of the follicle
User :   well, the sonologist has written this for the left ovary: cyst of 6.5 x 5 cm showing internal echoes
Doctor :   Lesser internal echoes has a good quality follicle
Doctor :   Are you with me?
User :   yes doctor
User :   so i think we have to bank on the right ovary, right?
Doctor :   yes
Doctor :   Did she stop Lupride now?
Doctor :   What are her current medications?
Doctor :   What is your age?
User :   last dose of lupride was on nov 17
User :   no medication going on for her now
User :   i am 41, she is 39
Doctor :   Can you send the scanned copy of the sonography report
Doctor :   to email ID
User :   sure
Doctor :   YYYY@YYYY
User :   ok
Doctor :   so that I can forward to Dr. xxxxxxx
User :   thanks
Doctor :   I shall wait for all the details
User :   the follicular study sono report will take time
Doctor :   If possible quote the complete query and complete questions
User :   as we were told that they will give the report only after the complete study isdone
Doctor :   Ok send what is available
Doctor :   and current finding
Doctor :   Prescription scans

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