Is laporotomy necessary to get conceive in PCOS/PMOS patients?

Question

Hello doctor,

I am 23 years old. I am married for one and a half years, with regular cycles and primary infertility. History of laparotomy for pseudo tumor intestine before 15 years. I had PCOS/PMOS. We have been trying to conceive for the past eight months.

My scan report shows:

Right ovary: 2.3 x 2.3 inches with multiple endometriotic cysts 31x44 mm, 15x20 mm, 19x25 mm, also clear cyst 23x24 mm.

Normal ovarian tissue present.

Antral follicle count 5-6.

Left ovary: 3.1 x 2.7 inches, endometriotic cyst 7x4.7 mm, 3.6x3.1 mm, 3.1x4.1 mm.

Normal ovarian tissue seen.

No antral follicle count.

Kidneys: Bilateral mild hydronephrosis.

My doctor suggested me laparotomy. What shall I do? I do not have any children. Is there any other procedure to get conceive first and after that let me do the operation for my cysts? Is there any medicine so that my cysts become small? Any other option except laparotomy? I need your suggestion.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your reports. (attachment removed to protect patient identity).

It is confirmed that you have PCOS/PMOS (polycystic ovarian syndrome/Polyendocrine metabolic ovarian syndrome) and endometriosis as well considering the large 3.9 inches cyst in the left ovary. Now, this cyst can be laparoscopically removed under experienced hands and then you can be placed on progesterone-only pills for at least three months for further control of endometriosis, and also on Myo inositol supplements for three months simultaneously to control PCOD/PMOS as well.

Post treatment there would be a good chance to conceive in the next six months with an ovulation induction and an IUI (intrauterine insemination) procedure and may even timed intercourse would prove fruitful. But that endometriotic cyst would have to be removed as that shall not regress with medications, not more than 1-1.5 inches in the next three to six months. Surgery would be mandatory and I still advise the laparoscopic approach considering primary infertility.