Brief Answer:
Ovarian cyst needs removal

Detailed Answer:
Dear XXXXXXX

I do empathize the situation of your friend.

The cardinal symptom of pregnancy is missing a period; all other symptoms may be associated with it. If those symptoms are present without missing the period, they could be due to some other cause. The uterus is an entirely pelvic organ and is not felt abdominally when of normal size. Because it increases in size during pregnancy, it is felt (and visually perceived) abdominally. However, it is only after 12 weeks of pregnancy that the uterus becomes an abdominal organ. Hence, budging out of the belly just after one month cannot be due to pregnancy. Even a woman gains around 11 kg of weight during pregnancy over a period of 240 days.
Increase in weight by 6 kg over a period of just one month has to be investigated properly.

Her Gynaecologist therefore very rightly investigated her and has found ovarian cyst. Ovarian cyst always needs to be removed surgically. One has to be sure whether the ovarian cyst is benign or cancerous.

Will you please update me with some more information:

1. What is her age?
2. What is the size of the ovarian cyst as measured by ultrasonography?
3. Does ultrasonography report mention any specific remark about the fluid in the cyst?
For both these issues, if you upload the ultrasonography images and reports, I can view them and form my own opinions.
4. Did she use to get pain in the abdomen or flanks, particularly during menstruation? If so, it suggests the presence of uterine lining in the ovary (endometriosis); i.e. chocolate cyst of the ovary which needs special attention and treatment.

If you want me to opine on her infertility issue also, please upload all the reports and images of BOTH of them.

Prima facae, the ovarian cyst needs to go. Since her doctor mentions that after having the menses after removal of cyst, she can try for pregnancy, it seems the cyst is small in size and is likely to be benign.

Yes XXXXXXX she should get rid of the ovarian cyst first. The eggs are being released from the ovaries. So presence of ovarian cyst may obstruct the release of the eggs. Moreover, if the cyst is hormone producing cyst, will hamper the egg release. After removal of the cyst, the couple should again get themselves evaluated for infertility issue. Then also, if you feel necessary, I can guide you further on this forum.

I hope, I have answered your initial query regarding the dilemma of cyst removal; however, I would urge you to upload the required images and reports and also provide me more information asked for so that I will have clearer picture to guide you further.

If you are satisfied with the answer and the information, you may post a review and rate 5 starts for me.

If you wish to have any more information from me, I am always available for you, XXXXXXX

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Brief Answer:
Get rid of the Ovarian cyst first, then attempt for pregnancy.

Detailed Answer:
Dear XXXXXXX

I am happy that my advice has given you some direction.

It is absolutely essential to know what kind of fluid the cyst contains - watery serous, mucoid or blood. The prognosis and many other decisions depend up on it. Also the size of cyst plays very important role.

You can upload the images with the reports on this forum. Many of my forum patients have uploaded their images and reports for my review. I would have loved to share my email id to you. However, I am not sure whether you will get it. Here it is YYYY@YYYY .

Now here are the answers to your queries:

1. After one month, the ultrasonography had revealed no pregnancy. By this time, the pregnancy is definitely visualized in ultrasonography. I will consider her non-pregnant.

2. You may try beta hCG test. It is very specific and sensitive test which can give very reliable results within few days of missed period. There is no harm in undergoing this test.

3. If it is a small chocolate cyst of the ovary due to ovarian endometriosis, some medicines can restrict its activity and growth. However, the cyst cannot be dissolved, it can be made non-functional. At the most, that too depending up on the pathology of the cyst, it can be aspirated through laparoscopy. All will depend up on the tentative diagnosis of the cyst which is based on the content of the cyst, size of the cyst and the appearance of the cyst. You may please ask this information to your Gynaecologist. We usually share all the details to our patients to empower them to take their own decisions.

4. It is unlikely that she will get pregnant with the cyst in situ. Moreover, she should not harbour the pathology in the ovary and try to be pregnant. Better get rid of it if it is required before she becomes pregnant to avoid any possible complications during pregnancy. Particularly with the history of previous ectopic pregnancy and one tube lost in that, I would suggest her to have her adnexa (area around the uterus) absolutely clean and clear before she becomes pregnant.

5. I am indeed not sure whether my email id will reach you through this communication. However, it is not necessary also. I am cent per cent sure that there is a facility of uploading the images and reports through XXXXXXX Care Magic platform. If still you cannot do it, you may ask the HCM how to do it. You are from XXXXXXX and so is this HCM. It should be easier for you to contact them and get your difficulty resolved.

I do appreciate her anxiety about the infertility. However XXXXXXX I feel please get this problem of ovarian cyst resolved and then we can discuss in details about the infertility issue. Meanwhile you may please upload all her and her husbands reports done for evaluation of infertility. I will go through them before I advise on that issue.

I hope I have clarified all your doubts. However, if you want to know any more information, I am always available for you, XXXXXXX

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Brief Answer:
New Villain now - Thyroid problem

Detailed Answer:
Hi XXXXXXX

I am indeed happy to not your response to my advice.

As you have very rightly mentioned the cyst is too small to get a proper view with laptop resolution. Please upload the reports of the scan. You can ask them to send the reports to both of us by email. However, the cyst seems to be filled with water. It could even be a overgrown follicular cyst also.

Let us hope your doctor's treatment resolves the ovarian cyst.

In the resolution, I could not see the contents of the uterine cavity clearly however, prima facae could not find any evidence of pregnancy. There is no harm in believing in the reports of the sonologiost.

Now a new villain has appeared on the screen and that is Thyroid problem with cyst. Thyroid problems do affect the fertility and even may cause so many problems in pregnancy. Please update me in details about her Thyroid problem. Initially get her T3, T4, TSH and scan of Thyroid done.

And XXXXXXX if the patient is in Singapore, how can I see her in Bangalore? Anyway, I am planning to visit XXXXXXX when I shall definitely try to meet you in person.

Will you please update me with the required information? I am waiting for the required information and documents. I will be clarifying any of your doubts, XXXXXXX

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Brief Answer:
Don't attempt pregnancy till intrauterine cyst is dealt & Thyroid evaluated

Detailed Answer:
Dear XXXXXXX

Unless I know about the detailed reports I have requested for, I will not be in a position to decide what treatment she should undergo for infertility.

I could not locate any cyst in the ovary, the cyst is in the uterus. It is filled with clear liquid. This uterine cyst could be endometrial cyst. The other theoretical possibilities include molar degeneration of the ovum, however, then there are multiple cysts. It could be an infective cyst also. Germinal sac without embryo (blighted ovum) also may appear like cyst, however, its edges are corrugated, hence I shall rule out that possibility.

The very fact that the doctor has hopes of get rid of the cyst with medicines suggests that he feels it is a benign endometrial cyst. If during the process of removal of the cyst, the lining of the uterus gets damaged, then she might have to be on the Oestrogen treatment for at least three months to build up the uterine lining. Otherwise her menses also might be affected. Probably, that is why the doctor suggested you to wait till she gets menses after the cyst has been dealt with.

Wait till the cyst is tackled successfully, then see the uterine lining and then only plan for the pregnancy. Any attempt for pregnancy, may be even IVF will probably not be successful since the uterine lining will not be capable of holding the pregnancy.

Also, Thyroid is a great hurdle in her becoming pregnant, and may be it will cause problems in continuing the pregnancy too. So please make no haste. Let us work on the case thoroughly before attempting for the pregnancy to avoid frustration.

Well XXXXXXX I am too keen to visit B'lore at the earliest, however, it does not seem to be possible in 2015. Let us see when in 2016. It is my word to you that when my plans are finalized, I shall definitely convey them to you. Meanwhile, please let me know your contact number.

If you are satisfied with our discussion, you may post a good review and 5 star rating for me.

I hope this will clarify most of your doubts. If you want any more information, I am always available for you, XXXXXXX

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