The most important reason why the chocolate cyst directly affects pregnancy is that the place where it forms consists of the main organs related to reproduction.
Although the cysts that form in the ovaries create a risk for pregnancy, it is possible to become pregnant. For those who want to conceive, other treatment methods are preferred rather than suppressive treatments such as contraception or delaying menstruation.
PREGNANCY IS POSSIBLE BETWEEN 6 AND 9 MONTHS
With the treatment of endometriosis the likelihood of pregnancy can be increased. One of the first options is generally the removal of the chocolate cyst by laparoscopic or robotic means. But the important point is the fact that we do not, and indeed should not, operate on every chocolate cyst we see. Because a significant number of patients can become pregnant on their own without any treatment.
The important points are that the group which cannot become pregnant on its own but could conceive with surgical treatment must be identified well from the outset. Laparoscopy is the general name given to the procedures of entering the body through a hole made just below the navel to examine the abdominal cavity and the internal organs and, where necessary, of performing the operation through additional holes.
This operation is not only quite easy but can also be preferred because it is a closed procedure. Today, unless there is a very exceptional situation, the chocolate cyst is not operated on by open surgery.
In women with a chocolate cyst, ovarian chocolate cysts can be removed with laparoscopy. Blockages in the tubes or endometriosis foci in the pelvis can be cleared. After this procedure, pregnancy on one’s own can be possible between 6 and 9 months.
After the operation, in patients with stage I or II disease the monthly chance of pregnancy increases by about 4-5%, while in patients with stage III or IV the increase is 1-2%.
Our patients must certainly know that in women operated on with laparoscopy or robotic surgery after a diagnosis of endometriosis, the highest chance of pregnancy is in the first six to nine months after the operation. This period, in which the chance of conceiving is highest, should not be spent using contraception.
THE CHOCOLATE CYST AND LOW OVARIAN RESERVE
Great care is needed especially in patients whose egg reserve is very low from the outset, who have had repeated endometriosis surgery or who have endometriomas in both ovaries.
Because the reserve is very limited, IVF quickly if the patient is married, or egg freezing if she is single, must certainly come to mind as a very important treatment option. Carrying out surgical treatment in these patients with a low ovarian reserve can bring more harm than benefit.
In patients in whom surgical treatment must certainly be performed, starting first with IVF, performing the surgical treatment after the eggs have been collected, and transferring the embryo after the recovery period clearly increases the chance of pregnancy.
THE CHOCOLATE CYST AND IVF
It is possible to increase fertility with IVF procedures. Because in vitro fertilisation (IVF) allows the sperm and the egg to be brought together in the laboratory, this method stands out for women with infertility linked to endometriosis.
If pregnancy has not occurred within 1 year after surgery, assisted reproduction treatments should be started. In infertile women with advanced-stage endometriosis, one can move directly to assisted reproduction treatments [in vitro fertilisation/embryo transfer (IVF/ET)] without surgery.
In an infertile woman, treating the chocolate cyst with medication is generally not applied in the treatment of endometriosis because it is of no benefit; on the contrary, it can delay the infertility treatment.
Here, without wasting time, if there is a wish for pregnancy this should be addressed first, and afterwards medical and/or surgical treatment can be considered. In patients with very severe pain and other complaints and with severely damaged tubes, IVF quickly, followed by egg/embryo freezing, then surgical treatment and, after a short recovery period, embryo transfer, emerges as a very important treatment option.
Changing eating habits can also be chosen in order to strengthen the immune system and reduce the existing endometriosis. Acupuncture and herbal treatments are also among the non-surgical treatment methods you may choose.
DO WOMEN WITH A CHOCOLATE CYST ENCOUNTER A PROBLEM IN PREGNANCY?
It is not impossible for women with a chocolate cyst to become pregnant, and there are many patients who were not aware of the chocolate cyst before becoming pregnant. Although pregnancy does not fully treat the chocolate cyst, during pregnancy chocolate cysts can be suppressed and the complaints are generally reduced.
In addition, it should be accepted that the chocolate cyst has no effect on the baby. Especially in recent years it has been stated that the chocolate cyst can also cause certain problems during pregnancy after conception.
These are premature birth, a low birth weight baby and early separation of the placenta. But there is no very definite evidence and most patients give birth to healthy babies.