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Ovarian Cysts Part One: Normal Ovulation

I need to write a few about cysts. I eventually want to get to Polycystic Ovaries, but I need to clarify the basics first. I will start with the cysts of normal ovulation.
The word “cyst” requires a long explanation. Cyst can mean a million things. A cyst is any fluid filled round thing growing on the ovary. They can be good, neutral or bad. In a woman who ovulates regularly there is one normal cyst produced every month. In the days leading up to ovulation, there is a cyst called the follicular cyst, or the follicle. It grows from a very small cyst of less than 10 mm in size to about 25 mm in size (2.5 cms or about an inch). The size can vary a bit, but most follicular cysts look the same on ultrasound from woman to woman. It’s filled with mostly fluid, but has some cells and one important cell: the egg. At ovulation the egg pops out, but the cyst stays around. The same cyst now takes on a different name: the corpus luteum (sometimes written as CL). The job of the follicular cyst is to make estrogen and develop the egg, the job of the corpus luteum is to make progesterone. The estrogen makes the lining of the uterus grow, and the progesterone makes the lining able to accept the embryo. The corpus luteum is a cyst, and it can vary in size, from small and difficult to see, to very large 2-4 inches, and easy to see. They are usually filled with blood. When they are large they can be painful, and they can sometime rupture, causing the sudden onset of pain. The corpus luteum dissolves away as the cycle goes along until there is nothing left. Therefore the source of progesterone goes away and this causes the period. This is all normal. It happens with every ovulation in every woman. So here we have a case of “cysts” that are good and normal. Sometimes these cysts are larger or look a little different than usual. In these cases we sometimes have women come back for a repeat ultrasound after their period, because this is when the ovaries should have only small follicular cycst(or follicles). In women who are pregnant, the early pregnancy makes the hormone hCG, which keeps the corpus luteum from dissolving, therefore there is no loss of progesterone and there is no period.

References:

  • Fritz MA, Speroff L. The endocrinology of the menstrual cycle: the interaction of folliculogenesis and neuroendocrine mechanisms. Fertil Steril. 1982 Nov; 38(5):509-29.
  • Baerwald AR, Adams GP, Pierson RA. Ovarian antral folliculogenesis during the human menstrual cycle: a review. Hum Reprod Update. 2012 Jan; 18(1):73-91.
  • Son WY, Das M, Shalom-Paz E, Holzer H. Mechanisms of follicle selection and development. Minerva Ginecol. 2011 Apr; 63(2):89-102.

Your Doctor’s IVF Pregnancy Rates are Available to You

The majority of reputable IVF clinics are members of an organization called SART. This stands for the Society of Assisted Reproduction. Almost all members SART submit their pregnancy rates, via computer, to the SART office. SART then works with the Center for Disease Control (otherwise known as the CDC) and produces a report. This report has the pregnancy rates for each clinic in the country. It can be viewed by going here:
http://www.sart.org/
Just click on the state and look for your clinic.
The charts are a little confusing. Pregnancies mean just that, so some pregnancies end in miscarriage. You want to look at the live births per retrieval. This means the chance of having a baby if you made it to the point where your eggs were removed. Once you see this clearly, it’s easy to click onto any clinic’s page and look at their rates for comparison. If your clinic is not listed, that’s a very bad sign. Some are not listed because they are too new to get on, but most who don’t report don’t report for a reason: their numbers are low. There is no excuse for a clinic not to report. Some will say they don’t report to SART because SART does not calculate the numbers correctly: not so.
You can also see that there is a delay in reporting. This is because deliveries occur well after the IVF cycle, plus it takes some time to get the reports out. This gap will decrease as SART improves its computer technology.
If your doctor doesn’t report, beware. If your doctor blurts out numbers (this is really common), the numbers are usually exadurated. Go to the web and check the facts yourself. And don’t listen to anyone who says their numbers are lower because they take the harder cases. The clinics with the best numbers have the best reputations and attract many many women who have failed other clinics first.

Pregnancy Rates Matter

You have choices. Many of you live in areas where there is more than one IVF center. Choosing a center is one of the most important decisions you will make. How do you choose? Well, most of us get a referral from a friend or doctor, and then go and check it out. If we like the doctor we saw, we assume he or she is the very best, and go with the recommended treatment plan. Well, there are a lot of clinics that are very popular, get many local referrals and have very nice doctors and staff. The problem is that many of these clinics have low pregnancy rates, and they are not advertising this fact. Why does it matter? Compare a good clinic with a pregnancy rate of 50% to a not so good clinic with a 30% pregnancy rate. The math is easy: out of 100 patients, 50 had a baby on their first try at clinic 1, while only 30 had a baby at clinic 2.
Don’t ever listen to a doctor or nurse who gives you pregnancy rates that are not in writing. Next post I will tell you the real way to get pregnancy rates from each clinic.