QuestionDear Dr
How do look upon having an egg-donation IVF treatment while having endometriosis with a cyst of 3-5 cm. Should one take it away or not before the treatment? I'm from Sweden and two doctors say I should leave it because it won't affect the treatment. The Czech doctor thinks differently. The endometriosis have not caused me any pain during 20 years and were using an egg donation because of poor egg quality and age.
Thank you!
AnswerHello Anna from Sweden,
That is a very interesting question. Thank you for asking me.
Technically, if you are going to do Donor IVF, your ovaries are not required and therefore will not interfere with your possibility of getting pregnant. That being said, however, there is evidence that any endometriosis can impair pregnancy even with IVF, especially if it is more advanced. The theory is that it elicits a significant immunological (inflammatory) reaction that can reach the uterus and prevent implantation. By advanced, we are referring to stage III or stage IV endometriosis, but it probably can be lower stages as well. If the cyst that you have is an endometrioma (an endometriotic cyst), which is fairly readily identifiable by ultrasound and a CA125 test, then that would stage your endometriosis as stage IV. Because of this potential risk to getting pregnant, and the cost of donor IVF, I would probably recommend that it be removed laparoscopically prior to doing the IVF. Keep in mind, however, that this recommendation is not because it absolutely needs to be removed, but more because when I do IVF, I want to make sure that there is nothing present that has the potential to interfere with its success. And an endometrioma has the potential to interfere. Also, in the U.S., Donor IVF is very expensive so I don't want my patients to risk that much money with something that could potentially cause it to fail.
The only reason why there is any dispute about removing the endometrioma is because you are not using your own ovaries. If you were, there would be no question about removing it first. The issue is whether or not it can affect a donor IVF cycle. I don't think this has ever been tested or looked at. If the cyst is not an endometrioma, but a simple cyst (clear fluid filled), then it does not need to be removed for the sake of getting pregnant, but the other worry would be whether or not it is pre-cancerous or cancerous. The fact that it has been there for a while would rule against the worry of cancer, but you can never know until tissue is removed. So that would make another reason to have it removed first.
The other potential problem is if you don't have it removed and get pregnant, sometimes because of the growth of the uterus, the ovary could become twisted upon itself from the weight of the cyst. This is called ovarian torsion. That would be a serious and emergent problem and then you would have to have emergency surgery, while you were pregnant, to have the ovary removed. The surgery could be a potential risk to the pregnancy because of the anesthesia and other medications that will have to be given. This would be another reason to have it removed (although less risk because the cyst is small).
So for all these reasons, my recommendation would be to have it removed laparoscopically prior to doing the IVF. Laparoscopy is a fairly simple and easy procedure, and is done as an outpatient in the U.S. (no hospital stay). Recovery is only about 4-7 days. You would have to wait at least 6 weeks from the surgery before doing the IVF, however, because of the inflammation that the surgery will cause.
I hope this helps in your decision making.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
