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Dana-Alicia
December 2nd, 2015, 04:19 AM
Hello dr. Braverman,

Not sure if you still come here and I really wish I could come see you personally, but due to the distance and finances this is not possible right now :( However, I do hope you are able and willing to have a look at my story.

I have always been regular in my cycle (my cycles being on the short side between 23-25 days) and have gotten pregnant the first month of trying. My ovulation was always very obvious to me, I have come to know my body well. In november 2012 I was diagnosed with bechterew disease, but since I was nursing still I did not take NSAIDS, I lived on ibuprofen and paracetamol. In october 2014 I weaned my son off and started using arcoxia. This has relieved the pain and stiffness in my back and pelvis a lot! I did notice however my cycles were getting shorter and shorter, between 18-21 days. Still with an obvious ovulation and 14 days after my period would start. Since april 2015 however, my cycles have become long. Usually around 42 days, with no sign of O at all. I have had 2 good short cycles in between with an O though. A few weeks ago, I started to have terrible abdominal pains, which I recognized probably being a cyst in my ovary. I have had them before (when I was not on any medication) and was told they are folliclecysts. Only one at the time though and they would disapear on their own. This never affected my fertility at the time. I went to see my new ob gyn at the hospital (we recently moved) and he referred me to the fertility department. There they did bloodwork and made scans. I started out with two cysts on my left, one being 3,5 cm and the other 5,5 cm. On my right the ob saw a follicle that was about to pop, so was very excited about this! However, I have been taking 2 ovulationtests a day (sensitest as adviced by the hospital for their accuracy) since day 5 of my cycle and have not even seen a glimpse of a second line. A few days later I started getting the same sharp pains and bloating on my right side. I feared my pretty follicle had become a cyst as well. Yesterday I was back at the hospital and on the scan there was indeed a cyst on my right side, 4,3 cm. And on the left the other cysts are still there. My bloodwork showed I had had an ovulation! I'm in pain and I'm worried this will affect my fertility, as the doctor could barely see my ovaries anymore, it was just one big cyst or cysts. My bloodwork is normal, but probably not with the same standards as used in the US:

first testresults:
TSH 1.8
T4 12.9
LH 4
FSH 7
Prolactin 0.15
Progesteron 1.9
Oestradiol 103 (seems to be on the low side maybe? normal is between 100-1150)
Testosteron 0.8
SHBG 51
vry testost. 0.011
DHEA-S04 8.4

second testresult:
progesteron 2.0
Oestradiol 581

third testresult:
LH 5
Progesteron 20/H
Oestradiol 526

I have asked if the cysts can be removed due to the pain and discomfort, but they will not do so as the cysts are just regular follicle cysts and should go away on their own. And even if they did, next month I would just have a new set of cysts. Could you offer me any insight or advice on what to do next? Could my meds (arcoxia) be causing these cysts or is something wrong with my ovaries itself? Can i get pregnant with this going on in my ovaries? We have not been ttc yet as I feel it would not be safe right now due to my health issues atm. Hoping to ttc in june 2016. Thank you so much in advance!

Dr. Braverman
December 2nd, 2015, 10:05 AM
Hello dr. Braverman,

Not sure if you still come here and I really wish I could come see you personally, but due to the distance and finances this is not possible right now :( However, I do hope you are able and willing to have a look at my story.

I have always been regular in my cycle (my cycles being on the short side between 23-25 days) and have gotten pregnant the first month of trying. My ovulation was always very obvious to me, I have come to know my body well. In november 2012 I was diagnosed with bechterew disease, but since I was nursing still I did not take NSAIDS, I lived on ibuprofen and paracetamol. In october 2014 I weaned my son off and started using arcoxia. This has relieved the pain and stiffness in my back and pelvis a lot! I did notice however my cycles were getting shorter and shorter, between 18-21 days. Still with an obvious ovulation and 14 days after my period would start. Since april 2015 however, my cycles have become long. Usually around 42 days, with no sign of O at all. I have had 2 good short cycles in between with an O though. A few weeks ago, I started to have terrible abdominal pains, which I recognized probably being a cyst in my ovary. I have had them before (when I was not on any medication) and was told they are folliclecysts. Only one at the time though and they would disapear on their own. This never affected my fertility at the time. I went to see my new ob gyn at the hospital (we recently moved) and he referred me to the fertility department. There they did bloodwork and made scans. I started out with two cysts on my left, one being 3,5 cm and the other 5,5 cm. On my right the ob saw a follicle that was about to pop, so was very excited about this! However, I have been taking 2 ovulationtests a day (sensitest as adviced by the hospital for their accuracy) since day 5 of my cycle and have not even seen a glimpse of a second line. A few days later I started getting the same sharp pains and bloating on my right side. I feared my pretty follicle had become a cyst as well. Yesterday I was back at the hospital and on the scan there was indeed a cyst on my right side, 4,3 cm. And on the left the other cysts are still there. My bloodwork showed I had had an ovulation! I'm in pain and I'm worried this will affect my fertility, as the doctor could barely see my ovaries anymore, it was just one big cyst or cysts. My bloodwork is normal, but probably not with the same standards as used in the US:

first testresults:
TSH 1.8
T4 12.9
LH 4
FSH 7
Prolactin 0.15
Progesteron 1.9
Oestradiol 103 (seems to be on the low side maybe? normal is between 100-1150)
Testosteron 0.8
SHBG 51
vry testost. 0.011
DHEA-S04 8.4

second testresult:
progesteron 2.0
Oestradiol 581

third testresult:
LH 5
Progesteron 20/H
Oestradiol 526

I have asked if the cysts can be removed due to the pain and discomfort, but they will not do so as the cysts are just regular follicle cysts and should go away on their own. And even if they did, next month I would just have a new set of cysts. Could you offer me any insight or advice on what to do next? Could my meds (arcoxia) be causing these cysts or is something wrong with my ovaries itself? Can i get pregnant with this going on in my ovaries? We have not been ttc yet as I feel it would not be safe right now due to my health issues atm. Hoping to ttc in june 2016. Thank you so much in advance!

Maybe at this piont it might be prudent to get a laparoscopy and a good look at the ovaries. While there they can drain what you have. Its unusual for any medication to cause recurrent large cysts.

Dana-Alicia
December 2nd, 2015, 10:07 AM
Thank you!