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Hi Doctor,

This is Meghana Challa. Age 26. I am from Hyderabad, India. My last 2 periods are very painful. I feel the pain at lower abdomen.

So I consulted a gynaecologist and she asked me to take some tests related to that during my period cycle and MRI.

Below is the MRI report:
Right ovary measures 4.1 x 3.0 cms and Left ovary measures 3.3 x 2.9 cms.

E/o multiple small cystic lesions of various sizes in both ovaries showing T2 shine through, T1 bright signals not suppressed on fat sat images largest measuring 2.6 x 1.9 cms in right ovary. No soft tissue component/calcifications seen.

Impression: Bilateral ovarian endometriomas (Chocolate cysts)

CA-125 level is 253.

So, she suggested laproscopic srugery to remove the chocolate cyst and to diagnose whether any other nearby areas got effected or not.

My query is, with the above cyst measurement, is it ok to go for laproscopic surgery?

Category: Infertility Specialist

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Category: Infertility Specialist
 21 Doctors Online

Thanks for posting your query at
Actually there is no discrete endometrioma seen here.
The ovaries are enlarged, and multiple cystic lesions are seen.
Your symptoms fit with those of endometriosis, but first, I would advise a repeat ultrasound scan.
I have a doubt whether this is a chocolate cyst at all.
Even if you have definitive endometriosis, there is a first line of therapy - medical management.
Drugs / injections such as Lupride, Progesterone, Danazol can be tried first.
Simple OC pills / Progesterone only Pills also can be tried first.
Also, is pregnancy a concern here ?
Looking forward to hearing from you.

Take care.

Patient replied :

Yes madam, We are planning for a pregnancy from last 1 year. Doctor has done initial scanning also by keeping some kind of stick through my uterus. She has identified some abnormal cysts of size more than 2cms. And she said that it keeps growing every menstrual period cycle. So, to confirm about whether or not it is enddometriosis, she suggested CA-125 and other tests in which it is found >200. Int the MRI and found that 2.6x1.9 cms cyst is present and that it is a chocolate cyst.

Well even if it is confirmed that it is endometriomas, you can try medical management first.
If you are trying to conceive, then it might make sense to remove the endometriomas first surgically and then plan for fertility treatment.
The risk is that normal ovarian tissue might be lost, resulting in decreased ovulatory capacity.

Patient replied :

Madam, are you saying that even with the chocolate cysts present, by taking medication can I try to conceive?

See, a chocolate cyst is a variant of endometriosis.
Endometriosis manifests in various ways - spots, burns, cysts, adhesions, bands.
Endometriosis can be given a trial first with medication, and then surgery if it is does not respond to medicines.
If fertility is a top priority, then surgery is faster .
The risk with surgery is that along with the cysts, part of normal ovarian tissue too maybe removed.
That is what I was trying to explain.
The choice is yours.
I would have liked a repeat transvaginal ultrasound scan to know the extent of the cysts.

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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