Showing posts with label Chocolate Cysts. Show all posts
Showing posts with label Chocolate Cysts. Show all posts
Do we try IVF first or have surgery to deal with adenomyosis instead?
7/20/2018 11:00:00 AM
I believe that many women have the experience of dysmenorrheal; but, it doesn’t mean that it is endometriosis, especially is adenomyosis. At the fertility stage, if you are diagnosed with adenomyosis, doctors always say "pregnant is the best treatment."
We all know that In VitroFertilization (IVF) is the fastest and most promising way to be pregnant.
However, which is priority?
Do we try IVF first or have surgery to deal with adenomyosis instead?
We all know that In VitroFertilization (IVF) is the fastest and most promising way to be pregnant.
However, which is priority?
Do we try IVF first or have surgery to deal with adenomyosis instead?
Many people get the information whether from doctors or internet have positive and negative opinions. As opinions vary, no unanimous conclusion can be drawn. Therefore, before making any decisions, you should understand the pros and cons of two options.
What is the adenomyosis?
We must understand the endometriosis first. As the name implies, it means that the endometrial tissue is present entirely outside the uterus. The name of the disease we are familiar with is chocolate cyst. That is endometrial tissue abnormally attaches and grows in the ovaries and responds to monthly hormones. This tissue bleeds and fills the interior of these cysts with un-clotted blood. In contrast, the adenomyosis is a gynecologic medical condition characterized by the abnormal presence of endometrial tissue within the myometrium (the thick, muscular layer of the uterus).
Why does the endometrial tissue run into the myometrium? The real pathogenesis is not completely certain. Some studies indicate that the endometrial tissue may be squeezed into myometrium due to too much intrauterine pressure during delivering the baby or artificial abortion. But this is not the case; many patients had not been pregnant. Some even don’t have any sexual experience.
For patients with adenomyosis, the myometrium is filled with diffuse endometriotic lesions. Therefore, the uterus will become larger, and in severe cases it can be several times larger than the normal uterus.
And it will cause intensive contraction of the myometrium, which will make the blastocyst difficult to implant, or easy to abort and premature birth after pregnancy.
And it will cause intensive contraction of the myometrium, which will make the blastocyst difficult to implant, or easy to abort and premature birth after pregnancy.
If choosing to treat adenomyosis with surgery, the basic principle is to "cut the roots of lesions in the myometrium” and excise it as much as possible so that the uterus can be completely "shaped" to the size of the normal uterus. However, leaving the broken uterus after surgery not only may cause the uterine cavity to deform, but also result in the blastocyst cannot be implanted successfully. It is also easy to hurt the ovarian function, result in a decrease in the number and quality of the oocytes, and affect the future treatment of IVF; Even, it may increase the risk of uterine rupture during pregnancy and threaten the mother and child's life. But, if excessively preserving the function of the uterus during the surgery, the symptoms cannot be completely cured. The pregnancy rate of doing IVF cannot be increased, and also wasting the time and health cost of the patient.
For women who are seeking pregnancy, the treatment must be different depending on the degree of symptoms and personal conditions. If the ovarian function is normal, in other words, the index of Anti-Mullerian Hormone (AMH) is above 2, and the age is below 38, you can consider the surgical reduction of the uterus, then treating it with the GnRH agonist such as Leuplin for 3 to 6 months, and then doing the IVF immediately. On the other hand, if the ovarian function has already been declining, we should undergo oocytes-retrieval several times to collect enough oocytes or blastocyst and then treat with surgery and injections. After the uterus is restored, we can have blastocyst transfer to increase the pregnancy rate.
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WhatsApp：Perseverance and spirit, secret of all triumphs
7/25/2017 02:00:00 AM
Josh Billings said,
“life consists not in holding good cards but in playing those you hold well.”
They do not have good cards;
They do have the perseverance and spirit
and overcame the premature ovarian failure and azoospermia eventually.
A quote of Taiwanese Poet, Xi Murong, is that “all in rush written in the book of youth.” Youth is like a blooming flower, at the brightest and most beautiful stage of the life. What is your definition of youth?
I still remembered the first day I met her. She came to our clinic for the health screening before getting married and prepared for the pregnancy. The uterine condition and fallopian tubes seemed normal. Unexpectedly, the chocolate cysts were found in her ovaries, with a declined AMH value as 0.76 mg/ml. The ovarian reserve showed severely declined, and it was unusual at her age (~20+ years).
Chocolate cysts is the symptoms of endometriosis which endometrial tissue grows out of the uterus, and in the ovaries. The cysts contain the menstrual blood, chocolate-like liquid, enlarging over months with the menstruation. Thus she often felt pain during the periods, but did not know the actual reason until now.
It was not the entire news. The results of her fiancé 's semen analysis displayed as azoospermia, which means that no sperm could be found in the ejaculated semen.
With such low AMH value, many people would choose to take the donated egg program. However, using the embryo generated from both donors' sperms and eggs is forbidden according to the reproductive legislation in Taiwan. The diminished ovarian reserve and azoospermia became two difficulties in getting pregnancy. Considering her age was still young, the fertility specialist recommended her to take the strategy of oocyte accumulation from multiple IVF cycles and to use the sperm bank.
She agreed with this suggestion. Instead of a fixed stimulation protocol, her doctor designed an individualized protocol to adjust her ovarian function. In her first IVF cycle, four mature eggs were collected and it encouraged them to continue the other programs.
Then their wedding followed behind.
In the wedding vows, they promised each other,
"I will love you, hold you and honor you,
I will respect you, encourage you and cherish you,
In health and sickness,
Through sorrow and success,
For all the days of my life."
After becoming the husband and wife, they came to the clinic every month to continue the oocyte collection. It was just like running a marathon, and some accidents happened. Eventually, the egg collection took her almost 22 months.
The embryologists performed the artificial insemination using IMSI (6000x magnification) in her precious, frozen-thawed oocytes. The culture condition was controlled very well to grow the fertilized eggs into the blastocysts.
After transferring a blastocyst graded as 4BB, she finally got pregnant, and the beta-HCG level was 500 mIU/mL.
Youth is like a blooming flower, at the brightest and most beautiful stage of the life. Although the ovarian reserve was diminished, the quality seemed not being affected by the maternal age adversely yet. With her whole perseverance and spirit, they finally start a sweet family.
Her clinical outcomes were showed as below,
It's bitter-sweet to have a baby
3/18/2014 07:27:00 PM
Looking at the genuinely sweet smile on my baby's face,
I just felt indescribable joy.
If I didn't feel the warmth from this tiny thing,
I would think that I was still in my dream.