Surgical Intervention For Ovarian Endometriosis With Kissing Ovaries And Fertility Outcome.
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 8, Pages 1590-1595
AbstractIntroduction: Endometriosis is a state of chronic inflammation in the pelvis and is characterised by endometrial-type tissue outside of the uterus. Although exact prevalence of endometriosis is unknown, it roughly affects 2 to 10% of the female population, but 30 to 45% of females with infertility  Pelvic endometriosis commonly involve the ovaries, and bilateral involvement occurs in one third to one half of cases [2,3 ]. Ovarian endometrioma rarely exceeds 10–15 cm in diameter [2,3].
Case summary: A 25 Female, Nulligravida with married life of 3 years presented to the OBGY OPD anxious to conceive since 1.5 years. She also complains of intermittent Pain in lower Abdomen during menses since 1 year, aggravated during menses and relieved on medication.. She had a history of irregular cycles lasting 3-5 days between 28-60 day intervals with dysmenorrhea.Per abdomen was soft, non tender with no other significant findings. Speculum examination revealed white foul smelling discharge. On per vaginal examination, B/L fornices were found to be full but with no tenderness. White discharge noted as well. Radiological investigation was advised and a 3D ultrasound was done. Patient had mild adenomyosis with B/L bulky ovaries and multiple endometriomas with left hydrosalphinx. Patient was posted for a video
hysterolaparoscopy during which B/L endometriomas noted with kissing ovaries appearance. Bowel was adhered to the endometriomas and left hydrosalphinx noted along with endometriotic patches on POD. B/L endometriomas drained and hydrosalphinx excised. Adhesiolysis done. Patient withstood the procedure well and discharged two days later and asked to follow up in the OPD after full recovery for further infertility evaluation.
Conclusion: Endometriosis affects day to day life of a woman and fertility by making the in vivo environment harmful for an oocyte or an embryo. Theoretically, surgical treatment of endometriosis could create a more favorable environment for successful conception and relief of symptoms.
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