28 yr old patient ,primary infertility,married for 4 years was operated for grade 4 endometriosis and endometrioma excision done in 2016.
In the OT note Bilateral spillage from tubes mentioned.
Patient has been trying to conceive for 1 yr.
Husband “s semen reports are 20 million ,motility 40%,morphology 2% .
TVS shows recurrent endometrioma 2cms on rt side and 3.5 cms on the left side. Hydrosalpinx not noted .
What do we suggest …..
Prognostic factors for infertility are:1)age of the patient 2)duration of infertility 3)cause of infertility 4) male parameters.5)ovarian reserve.
Discussing the above parameters we suggest an IUI for 3-4 cycles for this patient with medicines and injections keeping in mind the success rate and the grade 4 endometriosis followed by IVF.
Counsel women with endometrioma regarding the risks of reduced ovarian function after surgery and the possible loss of the ovary. The decision to proceed with repeat surgery should be considered carefully if the woman has had previous ovarian surgery
Endometriosis is estimated to affect between 3% and 10% of reproductive-aged women. In women without symptoms 1-7% will actually have endometriosis diagnosed at the time of their surgery, as will 12-32% of women having surgery for pelvic pain, and 9-50% of women having surgery for infertility. Endometriosis is rarely found in girls before they start their period, but it is found in up to half of young girls and teens with pelvic pain and painful periods
Endometriosis and Fertility
Between 20 and 40% of women with infertility will have endometriosis. Endometriosis seems to impair fertility in 2 ways: first, by causing distortion of the fallopian tubes so that they are unable to pick up the egg after ovulation, and second, by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.