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Clomiphene Induced Cysts & Hydrosalpinx Lead to Fertility ProblemsFrom: Mary (anonymous@obgyn.net)Wed, 21 May 1997 07:44:05 -0500 (CDT)
I would appreciate any thoughts you may have regarding Clomiphene induced cysts & hydrosalpinx (fluid in fallopian tube). BACKGROUND I am a 38 yr old who had no infertility problems. In fact, I became pregnant 4 months ago the first time my husband and I used an ovulation kit. The pregnancy ended in a miscarriage at 5 weeks. I got my normal period back exactly 28 days after the miscarriage. Three months later, my physician (who just finished her residency) pressured me into taking Clomiphene (the lowest dose for 5 days), to try to speed things up by increasing my chances of a pregnancy. She told me that because of my age, my time was quickly running out. I was hesitant because I have always been a strong advocate against interfering with hormonal mechanisms - especially if they are operating normally in the first place. My appreciation of the finely tuned intricacies of hormonal regulation is due to my education in cellular and molecular biology. Prior to this I had no previous gynecological problems. No cysts, no fibroids, no blockages, periods every 28 days (except last month I was 20 days late for my period - this was due to daily intense cardiovascular workouts in an effort to lose 10 pounds in 2 months - it worked! I am 5 foot 7 and weigh 128 pounds. I have never used oral contraceptives, no IUD's, no history of any STD or PID. I have had the same partner (my husband) for the past 17 years. We avoided pregnancy by using condoms. My last menstrual period began on 4/19/97 and I began my first dose of Clomiphene on 4/23/97 and took my last tablet on 4/27/97. An ultrasound was done on 4/30/97 and two good sized follicles had formed. Four days later I experienced excruciating abdominal pain and on 5/5/97 another ultrasound was done. The follicles had grown considerably, and I had not ovulated as expected. Another ultrasound was done again on 5/9/97 . I still did not ovulate and the cysts had grown even larger. One cyst on my left ovary measured 5 cm and the one on the right slightly larger than 3 cm. On 5/16/97, another cyst-like structure formed - possibly a hydrosalpinx on the left fallopian tube associated with the 5 cm cyst. This structure is also approximately 5 cm. The other 2 cysts have not gotten any smaller. I am taking the necessary precautions to avoid positions, movements and activities that may cause torsion in that left ovary. I want to do everything possible to avoid surgery (including laparoscopy). My hope is that these will resolve on their own as quickly as possibly and with no damage to any parts of my reproductive system. QUESTIONS: How long will these take to resolve on their own (I know that the literature says 2-3 months)? My physician has never seen a case like this before; so I imagine that she also can only rely on what's in literature. The important questions that I have not been able to find answers to in any literature are: 1) Have these gigantic cysts caused any scarring inside my ovaries that would jeopardize their ability to form normal follicles on their own (without the use of drugs)? I am worried since they are larger than normal, and have been there longer than an average follicle. Would the surrounding cellular architecture be changed ? Would they form any kind of fibrous type of shell? If they do shrink and not rupture, would the scars be of normal size - like those from a normal corpus luteum and then a corpus albicans? Or would they take up more scar space than a regular degenerated follicle? I am worried that this incident would hasten the lifespan ability of my ovaries to produce follicles. I don't know - I'm not a MD or a GYN. Hopefully my fears are unfounded. 2) My other concern is the hydrosalpinx. What damage has that done to my fallopian tube? Will the swelling and inflammation cause scarring and mucosal damage inside that tube? I think that the cyst is located near the distal (fimbriated end). Could this hydrosalpinx (cyst) cause a blockage (either complete or partial) that may cause problems later on like complete blockage or a tubal pregnancy if ovulation resumes from that left ovary, and implantation occurs? My doctor didn't expect this to happen, and she told me that she doesn't know the answers to my questions. At least I give her credit for being honest. We are still friends. I feel that I have lost all hope of ever having a child now. Due to my past medical history, I will not be able to participate in any treatments for infertility which involve the use of hormones. I have had DIC, a deep vein thrombosis and cerebral embolisms after becoming infected with viral hemorrhagic fever in 1992. This, in addition to the hyperstimulation response I got from the lowest dose of Clomiphene, has scared me away from hormonal treatment. I only wish that I had never taken that drug. The sad thing is that it wasn't even needed in the first place, and I would probably have gotten pregnant on my own within the next couple of months. I would really appreciate your honest answers to my questions no matter how dismal. It is actually more stressful not knowing. I respect any other thoughts that you may have on my situation. I am trying to gather as many professional thoughts on this as possible. I regret that I had not done enough research on Clomiphene before taking it, and it is going to be hard to forgive myself for being so stupid. Thank you for your input. Mary Anne Kearns Kirkland, WA
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