CASE REPORT

Ovarian Cysts with Primary Infertility

Supervised by :
Dr. Hesty Duhita Permata, Sp.OG

Presented by :
Hasanah Suci Indriani
INTRODUCTION

Ovarian masses are a frequent
finding in general gynecology. An
ovarian cyst is a sac or pouch filled
with fluid or other tissue that forms
in or on an ovary.
The patient usually has non-specific
symptoms and appears well.
Symptoms may include abdominal
pain, bloating, changes in bowel
habits, urinary symptoms and pelvic
symptoms.
 Ovarian If not treated immediately can spread to the area
Primary
around the ovaries or turned into malignant cells
Cysts will be difficult to be cured and can caused
Infertility

Etiology Female factor ( Ovulation disorders, Tuba and Primary infertility is a condition
of pelvic factors, and uterine disorders )
where a couple, who have had no
Infertility previous pregnancies, are unable
to conceive.
Male factor ( Urogenital tract infection,
endocrin disorders, abnormalities of numbers,
motility, or sperm morphology )
CASE REPORT
Patient Identity

■ Name : Mrs. S
■ Date of birth /Age : 1st Oct 1983 / 35 years old
■ Address : Babakan Pangumbahan RT 01/19
■ Occupation : Housewife
■ Marital Status : Married
■ Religion : Moslem
■ Date of admission : 6th June 2018
■ Date of examination : 6th June 2018
 History Taking - Chief Complaint

Abdominal pain since 1 weeks before coming to RSUD R. Syamsudin

SH obstetric and gynecologic policlinic .
 History Taking - Present Illness

■ Abdominal pain since 1 weeks before

■ She felt bloating from lower abdomen
■ She had history of ovarian cysts 10 years ago about 4 cm and she
didn’t want to do any operation because she was not ready yet.
■ Patient has no history of using any contraception and she doesn’t
have any child yet.
■ The patient denied any vaginal bleeding out of her menstrual cycle.
■ She doesn’t felt pain during having sex.
History Of Past Illness Family History
History of surgery : denied History of hypertension : denied
History of hypertension : denied History of kidney disease : denied
History of diabetes mellitus : denied History of diabetes mellitus : denied
History of allergy : denied History of asthma : denied
History of asthma : denied History of malignancy : denied
History of malignancy : denied
History of past surgery : denied
Menstruation History Contraception History

Menarche 12 years old No history of previous

Menstruation cycle Regularly contraception
every 28 – 35 days, with 15
days of duration
First day of last menstrual
cycle 22nd May 2018
Marital History

Married once, she has

been married for 10
years.

Obstetrical History
(-)
 ■ General condition : Midly ill appearance
Physical ■ Consciousness : Compos Mentis

Examinatination ■ Blood pressure : 128/60 mmHg

■ Heart rate : 76 bpm
■ Respiratory rate : 21x/minute
■ Temperature : 36°C

Antropometric ■ Weight
■ Height
: 59 kg
: 160 cm
Status ■ BMI : 23,04 kg/m2
 General Examination

Head : Normocephal
Face : Symmetry
Eyes : anemic conjunctiva -/-, icteric sclera -/- edema-/-
Neck : Lymph nodes are not enlarge, thyroid are not
enlarge
Cor and Pulmo : Within normal limits
 General Examination
Abdomen
•Inspection : Convex, soft
•Auscultation : Bowel sound ( + ), normal
•Palpation : Palpable cystic at the left iliac region,
smooth surface
•Percussion : Dull at lower abdomen
•Extremities : Warm, edema - /-/-/-, Capillary refill
time <2 seconds.
•Reflex : Physiologic (+/+)
 GYNECOLOGY EXAMINATION

Bimanual examination
Vulva and vagina : within normal limit
Portio : smooth surface Inspeculo :
Corpus uteri : no enlargement Fluxus -, flour albus +
OUE : closed Portio : Soft surface
Left and right adnexa : palpable cysts
mass, size 12x8,3 cm, not mobile,
smooth surface, tenderness -
Cavum doughlas : within normal limit
USG Examination
Uterus normal, EL +, mass cyst size 12 x 8,3 cm papil (-) septa (-)

Supporting Examination
Ca-125

Management
Check Ca-125
Planning for surgical management

Prognosis
Quo ad vitam : bonam
Quo ad functionam : bonam
Quo ad sanationam : dubia
 WORKING DIAGNOSIS
Mrs. S, 35 years old with Ovarian cyst + Primary Infertility
CASE ANALYSIS
DEFINITONS

Ovarian Cyst

An ovarian cyst is a sac or pouch filled with fluid or other tissue that
forms in or on an ovary.

Primary Infertility

Primary infertility is a condition where a couple, who have had no

previous pregnancies, are unable to conceive.
 Ovarian Cyst Case Descriptions

✔️
• Female, 35 years old Age factor : Ovarian cysts often occur in women
of reproductive age
• History of familiy denied Genetic factor : Family history is an important

• Patient not already have child, and was

x factor, a woman has a risk of ovarian cysts.

✔️
married for 10 years, she said that want to Environmental factor : Stress and lack of activity
have child and thinking about it every day or exercise can trigger a disease.

Primary Infertility Case Descriptions

✔️
Female factor ( Ovulation disorders, Tuba and
pelvic factors,uterine disorders, and stress )

Male factor ( Urogenital tract infection, endocrin

x disorders, abnormalities of numbers, motility, or
sperm morphology )
DIAGNOSIS
Case Descriptions
Ovarian Cyst
✔️
A large cyst may be palpable on
abdominal examination. The cyst may be
Palpable mass at lower abdomen tender to palpation.

✔️
There are commonly increased frequency
of micturition,gastrointestinal symptoms
and a dull pain in the lower abdomen.

USG examination is still the gold standard for Radiologic Test

detecting cysts.
✔️ • USG : Uterus normal, EL +, mass
cyst size 12 x 8,3 cm papil ( - )
septa ( - )
Laboratory Test
• Ca-125 : 460,6 U/mL ( 0-35 )
DIAGNOSIS & MANAGEMENT
Ovarian Cyst
Consideration of surgery should be
made because the cyst does not
meet the criteria for conservative
management and the value of Ca-
125 is 460,6 U/mL it can be
possible that the mass in the ovaries
of this patient is malignant.
Primary Infertility
Case Descriptions
✔️
Women with a greater potetential for
malignancy are best managed by
laparotomy with midline vertical incision.
The provides surgical field large for
oophorectomy or cysts enucleation
without tumor rupture and for surgical
staging if malignancy is found
✔️
Infertility is defined as the inability to
conceive after 1 year of unprotected
intercourse of reseanable frequency.
DISCUSSION
What Is The Planning Management Of This
Patient ?

■ The risk of ovarian malignancy increases with age.

■ Women with a greater potetential for malignancy are best managed by laparotomy with midline
vertical incision.
■ Surgery must be considerated if :

• Complex ovarian cysts (unless thought to be haemorrhagic or corpus luteum).

• Functional ovarian cysts do not occur in late postmenopausal women.
• Postmenopausal simple cysts >5cm.
• The risk of malignancy is thought to be between 2% and 9%.
• Premenopausal simple cysts >7cm.
• There is concern regarding accurate assessment of the cyst wall beyond 7cm.
• Symptomatic.
• Suspicion of malignancy
How The Next Reproduction Function ?

■ The most important is reducing disability and rehabilitation so that ovarian cyst
patients do their activities again. Rehabilitation efforts are done with moral support
from the people closest to patients with postoperative ovarian cysts because the
patient will lose self-esteem as a woman. There is a relationship between the
support of the husband with the stress level of the wife (Women) who suffer from
ovarian cysts.
■ If the patient haven't been through the menopause, the surgeon will try to preserve
as much of reproductive system. It's often possible to just remove the cyst and
leave both ovaries intact, which means patient’s fertility should be largely
unaffected.
■ If one of ovaries needs to be removed, the remaining ovary will still release
hormones and eggs as usual.
 REFERENCES

■ https://emedicine.medscape.com/article/255865-overview. Ovarian Cysts. Jan 18 2017

■ Bain Catrina M.2011.Gynecology illustrated.6th edition
■ Hoffman. Gynecology Williams.2nd edition page 262
■ http://repository.unimus.ac.id/1562/3/5.%20BAB%20II.pdf
■ The American College of Obstetrican and Gynecologists. Ovarian Cysts
■ Analisis kesehatan reproduksi wanita ditinjau dari riwayat kesehatan reproduksi
terhadap infertilitas di rs margono soekardjo tahun 2015
■ Konsensus infertilitas