Ovarian Issues: From Ovulation Induction to Cancer Concerns

Ovarian issues

The last menstrual period was on April 7.
Since I wanted to conceive, I took ovulation medication on April 10.
On April 19, an ultrasound showed two follicles measuring approximately 1.9 cm, and no other issues were found with the ovaries.
Following the doctor's recommended schedule, we began trying to conceive.
On May 3, I took a home pregnancy test and saw two lines, with the second line being fainter.
However, I tested with three different brands of pregnancy tests, and all showed the same result.
I then went to a gynecology clinic for a check-up, where the doctor confirmed that I was pregnant.
An ultrasound was performed, but due to possibly insufficient gestational age, the gestational sac could not be visualized.
Instead, it was noted that both of my ovaries were enlarged, with the left measuring over 4 cm and the right over 3 cm, and there was also free fluid in the abdomen.
The doctor indicated that this was due to ovarian hyperstimulation syndrome from the ovulation medication, and that if I was pregnant, this condition could persist for some time.
Feeling uneasy, I went to the hospital for further evaluation and explained my situation to the hospital doctor.
An ultrasound was performed again, which also showed free fluid, but the doctor ordered blood tests to check for ovarian cancer markers and CEA levels.
I felt anxious, thinking that the clinic doctor had said this was due to the stimulation from the ovulation medication.
Why was the hospital doctor arranging for tests for ovarian cancer markers?

Xin Shi Zhong Zhong, 20~29 year old female. Ask Date: 2017/05/10

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The last menstrual period was on April 7.
Since I wanted to conceive, I took ovulation medication on April 10.
On April 19, an ultrasound showed two follicles measuring approximately 1.9 cm, and no other issues were found with the ovaries.
Following the doctor's recommended schedule, we began trying to conceive.
On May 3, I took a home pregnancy test and saw two lines, with the second line being fainter.
However, I tested with three different brands of pregnancy tests, and all showed the same result.
I then went to a gynecology clinic for a check-up, where the doctor confirmed that I was pregnant.
An ultrasound was performed, but due to possibly insufficient gestational age, the gestational sac could not be visualized.
Instead, it was noted that both of my ovaries were enlarged, with the left measuring over 4 cm and the right over 3 cm, and there was also free fluid in the abdomen.
The doctor indicated that this was due to overstimulation from the ovulation medication, a condition known as Ovarian Hyperstimulation Syndrome (OHSS).
The doctor mentioned that if I was pregnant, this condition could persist for some time.
Feeling uneasy, I went to the hospital for further evaluation and explained my situation to the hospital doctor.
An ultrasound was performed again, confirming the presence of free fluid.
However, the doctor ordered blood tests to check for ovarian cancer markers and CEA levels.
I was very anxious, thinking that the clinic doctor had said this was due to overstimulation from the ovulation medication.
Why was the hospital doctor arranging tests for ovarian cancer markers?
Answer: 1.
Ovarian Hyperstimulation Syndrome is typically caused by ovulation induction medications.
2.
The ultrasound confirmed the presence of free fluid, and blood tests for ovarian cancer markers and CEA were ordered to rule out the possibility of ovarian malignancy.

Reply Date: 2017/05/10

More Info

It sounds like you are experiencing a complex situation involving fertility treatments, ovarian health, and concerns about potential cancer risks. Let's break down your situation and address your concerns regarding ovarian issues, particularly in the context of ovulation induction and the associated risks.

Firstly, it is important to understand that ovulation induction medications, such as Clomiphene citrate or gonadotropins, are commonly used to help women conceive. These medications stimulate the ovaries to produce multiple follicles, which can increase the chances of pregnancy. However, one of the potential side effects of these medications is Ovarian Hyperstimulation Syndrome (OHSS). This condition occurs when the ovaries become overly stimulated, leading to enlarged ovaries and the accumulation of fluid in the abdominal cavity (ascites). Symptoms can include abdominal discomfort, bloating, and in severe cases, shortness of breath or significant weight gain due to fluid retention.

In your case, the ultrasound findings of enlarged ovaries and abdominal fluid are consistent with OHSS, especially since you recently underwent ovulation induction. While OHSS can be concerning, it is usually a temporary condition that resolves on its own after the stimulation is stopped. However, it is crucial to monitor your symptoms closely and maintain communication with your healthcare provider.

Regarding the concern about ovarian cancer, it is understandable to feel anxious when additional tests are suggested, especially after experiencing symptoms like abdominal swelling. The tests for ovarian cancer, including serum tumor markers such as CA-125 and CEA, are often used to assess the risk of malignancy, particularly in women with abnormal ovarian findings. However, it is important to note that elevated levels of these markers can occur for various reasons, including benign conditions like endometriosis, pelvic inflammatory disease, or even as a result of OHSS itself.

The recommendation for blood tests to check tumor markers does not necessarily mean that your doctor suspects cancer; rather, it is a precautionary measure to rule out any serious conditions. It is common practice for healthcare providers to take a comprehensive approach to patient care, especially when there are concerning symptoms or findings on imaging studies.

If the tumor markers return within normal limits, it is reassuring, but continued monitoring and follow-up ultrasounds may still be necessary to ensure that your ovaries return to their normal size and that the fluid resolves. If there are any persistent concerns or if your symptoms worsen, further evaluation, including a referral to a gynecologic oncologist, may be warranted.

In summary, while the use of ovulation induction medications can lead to complications like OHSS, the risk of ovarian cancer is generally low, especially in the absence of other risk factors such as family history or genetic predispositions. It is essential to maintain open communication with your healthcare provider, ask questions about your treatment plan, and express any concerns you may have. Your health and peace of mind are paramount, and your doctor is there to support you through this process.

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