26 જૂન In Uncategorized / By admin / No comments IVF and chocolate cyst Does each patient have a chocolate cyst need IVF? Chocolate cyst means endometriosis. 25-40% of infertile women suffered by endometriosis. Diagnosis by Symptoms: Pain during menses, during defecation, during sex, or chronic lower abdomen pain. Subfertility Ultra Sonography: Adhesion, Chocolate cyst in the ovary Laparoscopy examination of pelvic organs Why endometriosis/chocolate cyst cause infertility Reduced oocyte quality & count. Mechanical interference with oocyte pickup & transport. Hostile environment in pelvic organs. Suboptimal endometrial receptivity. Anatomical dysfunction and distortion of fallopian tubes and ovaries. Most chocolate cyst/endometriosis patients confused related to modes of treatment. Mode of treatment depends on the age of the patient, duration of infertility, and stage of diseases (early or advanced). Endometriosis categorized as Early endometriosis Only superficial peritoneal implant. Ovarian surface implant with no or mild adhesion. Diagnosed by laparoscopy. Advanced endometriosis Deep invaginating ovarian endometriosis with mild & sense adhesion. Deep pevic cellular tissue infiltration with dense adhesion. TreatmentIn early endometriosis In young patient (< 35yrs) – Ovulation induction for 5-6 months Laproscopy + Hysteroscopy IUI-H x 3 cycle IVF- last choice In >35yrs patient with other cause of subfertility Laproscope + Hysteroscopy IVF best option Advanced endometriosis Surgery or medical management followed by IVF is the most effective approach for fertility restoration than alone IVF. Surgery reduced volume of disease: Improve oocyte quality. Improved response of stimulation. Improved endometrium receptivity. Decision making for surgery Decision making depends on the following points. Excruciating pain > 5cm size ovarian cyst Previous Ovarian surgery Associated hydrosalpinx After surgery how long to wait for ART? In young women, the cyst is not very big, adhesions are moderate or minimum, anatomical restoration reasonable accomplished. Periods of two years allowed for spontaneous pregnancy or IUI – H If conditions are unfavorable – IVF planned within 3 month. In more than 35 years, ivf is the treatment of choice immediately following surgery.