Dear Professor Winston,
I am a 31 year old woman who has been trying to conceive for around two years. I had a miscarriage almost three years ago. Last year, I had a large dermoid cyst removed from my right ovary. Both ovaries and Fallopian tubes were left intact. The surgeon said there was no sign of endometriosis. I have always had very painful periods. Fallopian tubes were also flushed at this time, confirming that there was no blockages. My husbands sperm count and motility are normal. Progesterone level at day 21 was 22. My GP said that this confirmed ovulation. From examining cervical mucus, I am fairly certain that I ovulate around day 15/16. My cycle lasts only around 24/25 days and I am concerned that there is not enough time for implantation. I have tried acupuncture to help boost ovulation/ regulate cycle. I wonder if there are any other bloods/ investigations that I should have as I am very worried that this will never happen for me? I really appreciate your time. Kindest regards, K
Dear K,
Sadly, dermoid cysts are not the best news when it comes to fertility. For reasons which are not entirely clear, ovaries which had had these cysts do not always perform brilliantly even when they have been removed. Moreover they are often bilateral, affecting both ovaries. So it is just possible you may have a smaller cyst on the other side which has gone unnoticed, though this should show up on a carefully done ultrasound scan.
It certainly sounds as if you are ovulating – I agree with your GP and certainly the presence of cervical mucus is encouraging. I personally doubt that the short cycle is significant; people conceive regularly in 25 day cycles which is normal for many women. And I have to say, I know of no clear evidence that acupuncture will make the slightest difference – wild claims are frequently made for its effect on infertility in infertile couples, but it isn’t clear whether it really is effective and this needs further research.
My feeling is very strongly that you should have a laparoscopy. It would not surprise me to hear that you have adhesions around the ovaries and tubes following your surgery and even if the tubes are open, this could make a big difference. Adhesions are common after dermoid cyst surgery – so if you haven’t had a laparoscopy since the operation, this would be my first line of advice. These can then be treated, or IVF may be a good option to consider.
Best wishes
Robert Winston