USG suggests cyst on ovary or hydrosalpinx. What does it mean?

Hello,

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I have gone through your brief clinical history and the images you have provided. (attachment removed to protect patient identity). Though I would like you to answer a few more questions so as to provide you better diagnosis and suggest appropriate management. Are your menses regular? Is the flow normal, heavy or low? Do you have children? Normal delivery or cesarean sections? Any abortion, miscarriage or D and C done? Any history of urogenital infection or chronic discharge per vaginum? Now coming onto your query and analysis of the images you have sent. First image shows anteverted uterus with a 3.9 mm calcific focus in endometrial region. This calcification is most likely due to earlier infective or inflammatory pathology. Nothing to worry about. Second image shows minimal amount of clear fluid in the endometrial canal with thin endometrium for 9th day of cycle. Third, Fourth and fifth images show an oblong soft tissue structure adjacent to the left ovary. This could either be part of the bowel or fallopian tube (I can differentiate it on a dynamic scan or an ultrasound video rather than a still image). The left ovary looks normal with few follicles seen within it. No obvious cyst is seen in the image provided. Also, the left tube is not dilated and therefore no hydrosalpinx is seen. The last sixth image shows part of normal bowel loop in the right adnexa. No right ovary or dilated tube is seen in the image provided. I hope this helps. Thank you and take care.

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So what I suspected was right that you have a history of chronic genital infection which in your case is chlamydia. Fortunately, you seem to have taken a complete course of treatment for the same. However, these chronic infections are notorious to cause tubal block. I am into medicine since 21 years and have been doing gynecology ultrasound scans for almost a decade now. The finding of mild endometrial fluid is mostly innocuous and not uncommon and most of the cases resolve on their own or after a short course of antibiotics and anti-inflammatory medicines. In the three images provided (attachment removed to protect patient identity), the soft tissue measured in the left adnexa appears to be normal tissue. The black structure below the left ovary is mostly internal iliac vessel which supplies blood to the left ovary. The ovary appears normal in the image provided with few follicles within. As you are keen on conception, we need to check for your fertility status for which a battery of blood tests are required viz, FSH (follicle stimulating hormone), LH ( luteinizing), estradiol, inhibin, prolactin, insulin and testosterone. Since you have a history of chlamydia, chronic UTIs (urinary tract infection) and bacterial vaginosis we would like to check the patency of tubes. For this purpose, a test called HSG (hysterosalpinography) or sono-hysterosalpingography is advised. Thank you and take care.

Hello,

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This fluid has negligible chances of causing miscarriage if you get pregnant. Yes, A course of tablet. Doxycycline, along with anti-inflammatories such as Aceclofenac and Serratiopeptidase, may help in getting rid of the fluid and infection, if any. You are correct that your endometrial thickness should be at least 8 millimeters for conception. It is like a bed where the fertilized egg will get implanted and grow. Therefore it needs to be sufficiently thick enough to support that. Most doctors here start the patient on progesterone medications to support the endometrial thickness and thereby avoid chances of spontaneous miscarriage. Since your endometrial thickness is low, you will require the same. Do you suspect that mine reaches this considering it is only 2 millimeters on day nine of my cycle? I suggest you get a transvaginal ultrasound follicle and endometrial monitoring study done for at least two cycles. That will give an idea if your follicles are growing and rupturing at the right time to release the egg. Also, it will monitor your endometrial thickness on corresponding days. Yes, do send me the hormonal assay report to give you a better idea regarding your fertility status. If possible, send me a full ultrasound report which mentions the dimensions of the uterus and ovarian volumes. Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for the prompt revert with reports (attachment removed to protect patient's identity). The good news is Antral Follicle count (AFC) of 13 is considered good for fertility. The only limitation is the endometrial thickness of 2 millimeters. Fortunately, it can be taken care of with hormonal support medication. The inhomogeneous myometrium they have mentioned in the report is most likely due to chronic infection and inflammation you were suffering from. So, in my opinion, based on your ultrasound report, there is no significant structural problem seen either in your uterus or the ovaries. However, as mentioned in my previous reply, the tubal block cannot be ruled out, for which you need to undergo HysteroSalpinoGraphy (HSG) or Sonosalpingography. As I mentioned, take Doxycycline with a combination of Aceclofenac and Serratiopeptidase. You can take multivitamins and mineral supplements along with it, such as magnesium. Serratiopeptidase is a very good drug and does not hamper ovulation. I do not think you need to take N-acetylcysteine (NAC). Serratiopeptidase with Aceclofenac should be enough. Taking probiotics along with antibiotics is optional in your case. You may or may not take it as per your choice. One important thing for fertility is good mental and physical health. Try meditation, yoga, and cardio exercises. Avoid junk and fast food. Avoid too much cheese, butter, spices, white starch, Ajinomoto. Lastly, get your thyroid hormone status checked if you have not. This can contribute to fertility. (Serum TSH, freeT3, freeT4 levels) Let me know once you are done with all the investigations. Best wishes for your overall health, happiness, and fertility.

Thank you.