Infertility: Questions About Chocolate Cysts and Treatment Options

Q: Infertility: Questions About Chocolate Cysts and Treatment Options

Hello： For couples experiencing infertility with all tests normal, if an ultrasound raises suspicion of endometriosis, laparoscopy should be considered to confirm the diagnosis and actively treat the condition in order to improve the chances of pregnancy. <br>Hsinchu Hospital, De

Infertility issues?

I apologize for the lengthy message, but I would appreciate your response to my concerns.
I have been married for over three years, and initially, my husband and I decided to avoid having children early, so we practiced safe periods for intercourse and used withdrawal during fertile periods.
We did not use condoms or birth control pills, and I have no history of miscarriage or abortion.
However, since the beginning of this year, when we started trying to conceive, we have not had any success.
I have undergone examinations at a gynecologist, and both my fallopian tubes and uterus are normal.
My menstrual cycle is regular, and I have a luteal phase of about 14 days each month, with some fluctuations in basal body temperature, which my doctor said are not concerning (slowly rising and falling).
My husband's semen analysis also came back normal.

It was only after a transvaginal ultrasound that a 2x2 cm chocolate cyst was found on my right ovary.
I have a few questions:
1.) Does a chocolate cyst of this size require aggressive treatment? (My doctor told me that it does not and that regular monitoring is sufficient.)
2.) Is my infertility absolutely related to this chocolate cyst?
3.) On the morning of September 30, I received an ovulation trigger shot when my follicles were mature, and my doctor said it would help pinpoint my ovulation day.
I was instructed to have intercourse within the 36-hour window.
I returned for a follow-up on October 2, and ovulation was confirmed.
My doctor then prescribed 14 days of progesterone and advised that if my period does not come after finishing the medication, I should take a pregnancy test.
However, I have experienced intermittent bleeding over the past few days, which increased noticeably yesterday, although it is not as heavy as a normal menstrual flow.
Does this indicate that I have failed to conceive? Is my doctor's treatment approach correct? I have heard from others that they experienced similar bleeding but were still pregnant when they went to see a doctor.
Is it possible to have bleeding in early pregnancy? If I had such precise timing for ovulation and still did not conceive, does that mean I need to consider assisted reproductive techniques to become pregnant?
4.) I have also consulted with a traditional Chinese medicine practitioner, who said that both my husband and I are healthy.
Should I seek additional opinions from other doctors? What further tests would you recommend? I look forward to your valuable advice.
Thank you!

Xiao Fen, 20~29 year old female. Ask Date: 2005/10/15

Dr. Li Guanghan reply Obstetrics and Gynecology

Hello: For couples experiencing infertility with all tests normal, if an ultrasound raises suspicion of endometriosis, laparoscopy should be considered to confirm the diagnosis and actively treat the condition in order to improve the chances of pregnancy.
Hsinchu Hospital, Department of Obstetrics and Gynecology.

Reply Date: 2005/10/15

More Info

Infertility can be a challenging and emotional journey, and it’s understandable to have many questions, especially when faced with a diagnosis like a chocolate cyst (endometrioma). Let’s address your concerns step by step.

1. Treatment for Chocolate Cysts: The size of your chocolate cyst (2x2 cm) is relatively small, and many healthcare providers recommend monitoring such cysts rather than immediate intervention, especially if they are asymptomatic. Your doctor’s advice to observe and follow up is common practice. Generally, surgery is considered if the cyst is large, symptomatic, or if there are concerns about malignancy. Regular monitoring through ultrasound can help track any changes in size or symptoms.

2. Connection Between Infertility and Chocolate Cysts: While chocolate cysts can be associated with endometriosis, which may impact fertility, not all women with chocolate cysts experience infertility. Your other fertility assessments, including normal ovulation and your husband’s sperm analysis, suggest that the cyst may not be the sole factor in your difficulty conceiving. However, it’s essential to consider that endometriosis can sometimes affect the quality of eggs or the function of the ovaries, which could contribute to infertility.

3. Bleeding After Ovulation Induction: The bleeding you are experiencing after taking progesterone (yellow body hormone) could be due to several factors. It’s not uncommon for some women to experience breakthrough bleeding, especially if they are adjusting to hormonal treatments. Early pregnancy can also present with light bleeding or spotting, but it’s essential to monitor the situation closely. If the bleeding is heavy or accompanied by severe pain, you should contact your healthcare provider. It’s also possible to have a period even in early pregnancy, though it’s less common.

4. Further Investigations and Treatment Options: If you find that you are not conceiving after several cycles of trying, it may be worth discussing further evaluations with your doctor. This could include tests for ovulation, uterine health (like a hysterosalpingogram to check for blockages), or even a laparoscopy to assess for endometriosis if symptoms persist. Consulting with a fertility specialist could also provide additional insights and treatment options, including assisted reproductive technologies like IVF, especially if you have been trying for over a year without success.

5. Seeking Additional Opinions: It’s always reasonable to seek a second opinion, especially regarding fertility issues. Different specialists may have varying approaches to treatment, and it can be beneficial to explore all available options.
In summary, while your chocolate cyst may not be the direct cause of your infertility, it’s essential to continue monitoring it and discussing your concerns with your healthcare provider. If you experience persistent issues or if your attempts to conceive continue to be unsuccessful, further evaluations and possibly more aggressive treatments may be warranted. Remember, fertility can be complex, and it often requires a multi-faceted approach to achieve a successful pregnancy.

Similar Q&A

Understanding Chocolate Cysts: Fertility Concerns and Treatment Options

Dear Dr. Tsao, My wife and I are planning to conceive soon (both aged 35). Last week, my wife experienced abdominal pain, and I took her for an examination. The doctor initially indicated that it might be a chocolate cyst, measuring about 3 cm, and there seems to be only one. Af...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, a chocolate cyst does not necessarily cause infertility. If it is smaller than 3 centimeters and there is only one, the impact is even less, and it is advisable to take a wait-and-see approach without medication. The general definition of infertility is the inability to co...

Should You Choose Surgery or IVF for Chocolate Cysts and Infertility?

Hello Doctor, I am 35 years old and have chocolate cysts measuring 5 cm and 2 cm on my left and right ovaries, respectively. I have been struggling with infertility for a year. I initially considered surgery to remove the cysts, but I am concerned about my ovarian function due to...

Dr. Lü Lizheng reply Obstetrics and Gynecology
Dear Xiaoyu, Hello. 1. After the surgical removal of the cyst, there should still be a chance for natural conception. 2. I personally recommend that you first undergo surgery to address the cyst. 3. If you proceed directly with assisted reproductive technology without addres...

Understanding Chocolate Cysts: Treatment Options and Fertility Concerns

I underwent surgery for a chocolate cyst on January 4th of this year. The cyst was 10 centimeters in size, and I had laparoscopic surgery. However, once I was in the operating room and the surgery began, the doctor discovered that adhesions had enveloped my left ovary and fallopi...

Dr. Xu Junzheng reply Obstetrics and Gynecology
Chocolate cysts are a type of endometriosis, formed by the accumulation of endometrial tissue in the ovaries. The use of injections aims to induce a pseudomenopause through medication, with side effects that may include symptoms of menopause. However, once the medication is disco...

Understanding Chocolate Cysts: Causes, Risks, and Treatment Options

Hello, Dr. Hsu! I would like to ask: I experience severe pain every month, so I went to the hospital for an examination. Initially, after an ultrasound, the doctor suspected I had endometriosis, but after blood tests and a transvaginal ultrasound, he said I have a 3.3 to 3.8 cm c...

Dr. Xu Junzheng reply Obstetrics and Gynecology
1. Chocolate cysts are a form of endometriosis affecting the ovaries. 2. Laparoscopy is currently the mainstream surgical treatment for chocolate cysts. 3. Consideration may be given to injections and androgen therapies. 4. No. 5. There should be no direct correlation. ...