The question
Hello, I am trying to conceive and have been told the issue is I have a 5cm endometrioma. I am hoping to have this aspirated before starting any treatments. I do not want surgery to remove it as they want to take my ovary. Please let me know and if you do this or know someone who does I would love to make an appointment.
Answer from Dr. Geoffrey Sher
Advanced endometriosis is often associated with ovarian endometriotic cysts, known as endometriomas. In my opinion, such cysts, if numerous or sizable (>1cm) can and often do activate the surrounding ovarian connective tissue to locally produce excessive amounts of male hormones such as testosterone. This effect can often not be detected in the blood but nevertheless occurs in the affected ovary where, upon entering the follicles, it can i(n my opinion) compromise egg development which in turn often can result in abnormal egg development during ovarian stimulation. This can in my opinion, lead to increased numerical chromosomal abnormalities (aneuploidy), reducing egg/embryo competency”. Thus it is my opinion that any ovarian endometriomas larger than 1cm in diameter, should be removed eliminated before embarking on IVF.
Aside from compromising egg quality in the involved ovary, endometriomas can also cause severe and intractable pelvic pain, heavy menstruation (menometrorrhagia) and painful intercourse. They can also rupture leading to dissemination throughout the abdominal-pelvic cavity. Accordingly, they are best addressed sooner rather than later.
SurgicalTreatment: Conventional treatment of endometriomas involves complete surgical removal, usually conducted laparoscopically. Unfortunately, with surgery normal ovarian tissue can inadvertently be removed/damaged and result in scarring that that can compromise subsequent egg development in the affected ovary. Since many women who have endometriomas have already undergone previous surgery (ies) for endometriosis. Both the surgery (ies) and the advanced endometriosis will often have resulted in significant scarring and adhesion formation that can compromise subsequent visualization of, and access to anatomic structures during surgery, thereby increasing the risk of surgical complications. As such, many women with recurrent ovarian endometriomas are uncomfortable with the prospect of repeat surgery and its avoidance is often a factor in their decision to proceed with IVF.
Aspiration of sizeable endometriomas is unfortunately not a solution. The cyst will return! Removal surgically or laser ablation of the inner lining of the endometrioma is needed. And in the hands of an expert, the ovary need not be sacrificed. Failure to address removal or ablation will usually ensure that the vast majority of eggs produced by the affected ovary will be 'incompetent".
Geoff Sher
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Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure:
- From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf
- Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\
General information only, not medical advice for your own situation. For that, book a consultation.