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Suggest Treatment For Ovarian Cyst During IVF Treatment

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Posted on Thu, 27 Aug 2015
Question: hello,
i feel very worried about my situation; i took duphaston on 29th May till 7th of XXXXXXX because of irregular period, i took it for 10 days 2 tablets every evening. period started on the 9th XXXXXXX and i started the clomid on the 11th XXXXXXX finished on the 15th XXXXXXX and went for ultrasound control on the 18th XXXXXXX i had 2 eggs on the right side that was about 5cm each and doctor prescribed Pregnyl 5000 (humanes chriongonadotropin) , which i injected on my arm on the 21st XXXXXXX i went for IUI insemination on the 22nd XXXXXXX 2 weeks after i was not pregnant my period came out on the 8th July. my husband and i decided to go for IVF ,on the process it i had ultrasound on the 9th july(2nd day of period) and the follicles were fine on the left. I was given duphaston 5mg 2tablets at night and progynova1mg 2tablets in the morning and 2 at night, i took them from 23rd july the 16th day of period. On the 31st july i went for another transvirginal ultrasound control and a 4 inchs CYST was found at the right side, doctor said i should stop the progynova and continue with the duphaston for another 7 days. I was told to come for another ultrasound control on the 2nd day of my period , to check if the cyst has gone so i can start the treatment for ivf immidietly. Yesterday 10th july i went for it and the cyst is still there even added 1cm to it 4cm , it is 5cm now. i am very worried now as i ve never had cyst before in my life. i don't know what to do, it gives me a sleepless night. please i need an advice on what to do.
doctor
Answered by Dr. Sameer Kumar (47 minutes later)
Brief Answer:
Cyst probably requires removal

Detailed Answer:
Hello,
Thanks for the query to HCM,
The possibility of a simple ovarian cyst developing during a ovulation induction is common in a IVF cycle. A cyst of size 5cm would need laparoscopic removal because as long as the cyst is present there cannot be any ovulation induction done.
So there are two options:-
1. either you wait for 2 month and follow up with ultrasound to check for reduction in size of cyst.
2. or you can get a laparoscopic cyst removal done and in next month you can again get on with the ivf cycle.

As you have a failed IUI and one IVF cycle already and hence the presence of cyst in the ovary would deter the remaining follicles to grow and ovulate. Hence no drugs can be given to stimulate the ovaries as chances of hyperstimulation syndrome and possible rupture of cyst may occur which can be an emergency, so its better to stop with the ivf protocol and wait for the cyst treatment / removal as you plan.

Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sameer Kumar (3 hours later)
The doctor said i should stop every treatment as regards to ivf for now and wait till the next virginal ultrasound during my next period, since the cyst didn't go off in this month period am seeing now.
He went further to say that if it doesn't go off before my next period , then it will be punctured , but by puncture he said the cyst by grow back again, am soo scared.

which of this drugs can easily cause a cyst; clomid, pregnyl 5000 I.E, progynova, duphaston. i just need to know what caused this cyst.
doctor
Answered by Dr. Sameer Kumar (6 minutes later)
Brief Answer:
Answered

Detailed Answer:
Hello,
Yes the doctor is correct to stop your medications especially clomid, pregnyl 5000 and progynova, simply because they are ovulation inducing drugs and progynova ( estradiol) increases the estrogen environment and promotes LH SURGE. So all are actually responsible for teh cyst formation which is most likely to be a simple follicular cyst grown in response of ovulation induction. This needs to be removed if during your next USG, it still remains.
Puncturing is an option which can be done under transvaginal ultrasound guidance but the cyst wall would remain persistent and then it may regrow again. Hence i suggested a laparoscopic removal, so that the next cycles of ivf can be started soon after a month of surgery again.
Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sameer Kumar (28 minutes later)
Thank you very much. i will stick to the laparoscopic. Please is this laparoscopic painful? can it be done under Anastasia?
doctor
Answered by Dr. Sameer Kumar (5 minutes later)
Brief Answer:
minimally invasive...

Detailed Answer:
Hello.
Yes laparoscopy is done under general anaesthesia and is the preferred mode of ovarian cyst removal. Its the minimal invasive surgical route with just 3 puncture wounds and the whole surgery in done through those 3 holes and no need for any incision over abdomen.

Thanks for the consult. You may contact me directly whenever you need my opinion.
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sameer Kumar (16 minutes later)
ok thank you.
doctor
Answered by Dr. Sameer Kumar (17 minutes later)
Brief Answer:
Thanks

Detailed Answer:
Hello,
If you have no further queries , then you may close this query. Any help needed in future then please contact me at :-
http://doctor.healthcaremagic.com/doctors/dr-sameer-kumar/68814

Regards
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1782 Questions

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Suggest Treatment For Ovarian Cyst During IVF Treatment

Brief Answer: Cyst probably requires removal Detailed Answer: Hello, Thanks for the query to HCM, The possibility of a simple ovarian cyst developing during a ovulation induction is common in a IVF cycle. A cyst of size 5cm would need laparoscopic removal because as long as the cyst is present there cannot be any ovulation induction done. So there are two options:- 1. either you wait for 2 month and follow up with ultrasound to check for reduction in size of cyst. 2. or you can get a laparoscopic cyst removal done and in next month you can again get on with the ivf cycle. As you have a failed IUI and one IVF cycle already and hence the presence of cyst in the ovary would deter the remaining follicles to grow and ovulate. Hence no drugs can be given to stimulate the ovaries as chances of hyperstimulation syndrome and possible rupture of cyst may occur which can be an emergency, so its better to stop with the ivf protocol and wait for the cyst treatment / removal as you plan. Regards