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Have complicated ovarian cyst and subserosal fibroid. Got period after positive HPT. What's wrong?

Mar 2016
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Practicing since : 2011
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I had gone for ultrasound as I had bleeding and cramp on cd 19.My ovulation happened around by cd 14(checked thrugh opk and blood test was showing lh:54.2miU/ml,E2:285.2pg/ml ).The report showed that I have a complicated ovarian cyst in my right ovary of 3.7cm size and a subserosal fibroid of size 8.7cm*8.2cm.I was aware of fibroid but didnt know about the cyst.Did an ultrasound in Oct2012 and both the ovaries were normal.I was on Fertomid 50 since last 2 months.The beta hcg test on cd 14 was showing value 141miU/ml.
I am on progestrone(susten 200) for bleeding...1cd was 10 XXXXXXX
In the month of january I had performed a pregnancy test,it showed me positive but next day only i got i thought that a false pregnancy test.

What am I supposed to do.What if i'll become pregnant?how to treat a complicated cyst?and how come it can grow this big in 2 months?
Posted Thu, 21 Feb 2013 in Women's Health
Answered by Dr. S Patra 1 hour later

Thanks for posting your query. I am trying to answer your question.

First of all, your blood test report on day 14 is within normal range and suggests that you ovulated. As you get positive pregnancy test with mild spotting/bleeding, you should confirm intrauterine pregnancy by viewing gestational sac around 4 weeks (from last menstrual period) on Trans Vaginal Sonography (TVS) scan at the earliest. It also helps in assessing viability of the embryo.

According to your history, ovarian cyst may be presented as corpus luteum cyst which is more common with using ovulation induction drug (fertomid). Though it can give false positive pregnancy test, TVS scan is the most reliable for the same.

If corpus luteum cyst is formed with pregnancy,there is nothing to worry. It lasts till about the arrival of the second trimester. Most often, they slowly dissolve and disappear without causing any complications. Also size of the cyst is not big enough for immediate interpretation. It does not grow too much in later months.

In addition, if it is a plain or complex ovarian cyst, then at this stage, size of cyst (3.7 cm) usually does not interfere pregnancy or cause any complication. During pregnancy period, repeated ultrasound scan (USG) is advisable in 3 months interval for assessment of the baby as well as the cyst. In such case, ovarian cystectomy can be done during delivery by caesarean section. It is widely acceptable.

Surgical removal of the cyst by laparotomy (open method) is only indicated if it is more than 7 cm in non pregnant state. Otherwise, laparoscopic ovarian drilling with laser is the ideal procedure to treat single or multiple cyst which may interfere ovulation.

An other thing, I want to highlight that size of sub serous fibroid is quite large. Though, it does not interfere with pregnancy, it can be removed during caesarean section delivery. Here myomectomy (remove only fibroid) is the procedure of choice if it is operable.

Therefore, I urge to consult with your gynecologist regarding this for next line of management.

In this stage, complete bed rest and taking progesterone medication are the mainstay of treatment till you undergo TVS scan. Don't be worried or stressed.

Hope I have answered your query. If you have any further questions I will be happy to help.

Dr Soumen

Above answer was peer-reviewed by
Follow-up: Have complicated ovarian cyst and subserosal fibroid. Got period after positive HPT. What's wrong? 16 hours later
I had been to my gyn and she told me that the cyst could be a corpus luteum,we can start the treatment for the cyst only after seeing the day 2 of next menstrual cycle result.For pregnancy she said it is too early to say anything on this...And she asked to take Folic acid,Ecosprine,M2-tone.So,Is there is any chance of the corpus luteum to be of 37mm after ovulation???

Answered by Dr. S Patra 42 minutes later

Thanks for follow up query.

Usually corpus luteum cyst is small in size and does not enlarge in later weeks. As you used ovulation induction drug (fertomid), then there is always chance of formation of corpus luteum cyst after ovulation.

First you should confirm pregnancy by viewing gestational sac on 4 weeks (from LMP) by TVS scan. After that, you choose the option for treatment of the cyst. Your treating doctor also tell the same thing.

I already told you that there is nothing to worry with corpus luteum cyst if you are pregnant. Most of them dissolve slowly and disappear in first trimester without causing any complications. Therefore, you completely remove dilemma from your mind and hope for positive result.

You should continue above prescribed medication to support pregnancy and avoid miscarriage along with complete bed rest.

If you do not have any clarifications, you can close the discussion and rate the answer.
Take care yourself and stay healthy.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Have complicated ovarian cyst and subserosal fibroid. Got period after positive HPT. What's wrong? 21 hours later
I want to ask if what we are seeing is a corpus luteum cyst,then where is the corpus luteum of the egg that got fertilized(if any)...can we see a corpus lutem this early??Does seeing no corpus luteum means that no egg had released from the ovary?
Answered by Dr. S Patra 1 hour later

Thanks again for follow up query. I am giving answers to all your questions.

1) The corpus luteum develops from a graafian follicle during the luteal phase of the menstrual cycle after the release of egg (ovum) from follicle during ovulation. Ovum gets fertilized by traversing fallopian tube and corpus luteum remains in the ovary.

If the egg is fertilized and implantation takes place, the syncytiotrophoblast cells of the blastocyst secrete hCG and signals the corpus luteum to continue progesterone secretion.

If the egg is not fertilized, then corpus luteum stops secreting progesterone and destroys itself after 14 days following ovulation.

Corpus luteum cyst is a functional cyst that occurs only after releasing an egg from a follicle. It may contain blood or fluid and if it is enlarged more than 10 cm,then there is risk of rupture or XXXXXXX bleeding. Though chance is very much low. Ovulation induction drugs increase the risk for development of this type of cyst after ovulation. Though these cysts don't prevent or threaten a pregnancy.

2) Yes, we can see corpus luteum through TVS scan only after ovulation or egg released.

3) Yes, if egg is not released from follicle, then there is no formation of corpus luteum at all. Actually, egg less follicle is called corpus luteum.

I think that I have cleared your all doubts. In this stage, your next step is proceeding for TVS scan on 4 weeks (from LMP). Don't be much worried.

If you do not have any clarifications, you can close the discussion and rate the answer.

Dr Soumen.
Above answer was peer-reviewed by
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