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Overcoming Chocolate Cysts
Dr. Horng Shan Gwo
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A Journey of Perseverance: J Success Story
J's case is anything but ordinary. At 36, she faced numerous challenges on her path to pregnancy, including obesity, chocolate cysts, complex endometrial hyperplasia, and premature ovarian failure. When she first came to my clinic over a year ago, she had been trying to conceive for a long time without success.
Facing Multiple Obstacles
Her first challenge came to light during our review of her medical history. Previous surgeries to remove chocolate cysts from both ovaries had resulted in premature ovarian failure. A subsequent ultrasound revealed a low antral follicle count of less than five and a thickened endometrial lining, leading to a diagnosis of complex endometrial hyperplasia.
Despite having experience treating patients with endometrial cancer and successfully facilitating IVF, I consulted with a colleague in gynecologic oncology. We started her on progesterone and metformin. To enhance the treatment, we also included letrozole. Fortunately, after six months, her endometrial lining returned to normal. Following a repeat biopsy three months later, we were cleared to proceed with IVF.
Continued Challenges Ahead
However, challenges persisted. Due to previous ovarian surgery, her ovaries had adhered to her uterus, complicating measurements and making it difficult to distinguish between true follicles and fluid accumulation. During her first egg retrieval, only two eggs were obtained, resulting in one embryo. Given her endometrial hyperplasia, a second retrieval yielded four eggs and two embryos.
After a pathology report confirmed benign results, we prepared for embryo transfer. Given her BMI of over 38.5 and the complications of endometriosis and hyperplasia, I opted for a high dose of progesterone. Unfortunately, this decision led to the risk of early opening during the implantation window.
During the transfer of two embryos, positioning was complicated due to her weight and uterine adhesions.
A Joyful Outcome Amidst Trials
Ultimately, J successfully became pregnant with twins. However, this joyful news came with its own set of challenges, including a high-risk pregnancy that posed risks for premature birth. Given her circumstances and her family’s wishes, carrying two babies seemed destined.
At 18 weeks, she underwent amniocentesis with Dr. Chen from Taoyuan Dianthus for high-level ultrasound screening. Thankfully, she did not experience issues such as gestational hypertension or diabetes.
As her pregnancy progressed, her D-dimer levels were elevated, indicating a risk for embolism. We took preventive measures, and on August 22, at 35 weeks and 6 days, she underwent a C-section. Despite complications during delivery due to placental implantation, she and her two beautiful daughters triumphed.
A Celebration of Love
On Valentine’s Day, the new dad was there to welcome his two little girls into the world. Although the journey was fraught with challenges, the love and support they found in each other made it all worthwhile.
I encourage couples facing difficulties in their fertility journey to reach out to me. Our professional team is here to assist you in achieving your dreams. I look forward to seeing you and helping you through this path.