I describe the two main common pathologies that directly affect the ovarian anatomy and future fertility, that can be safely and effectively treated with advanced laparoscopic surgery. I provide this service at the excellent ODS Operating Theatre of IASO Hospital in Athens.

Endometriosis

It is a common benign condition where endometrial cells grow outside the uterus. It is probable that these cells during the period move “backwards” inside the abdomen. There they are implanted in various places, usually on the surface of the ovary, on the inner wall of the abdomen, and even on the intestine. These ‘implants’ are affected by the cycle and hormonal changes, just like the endometrium.

So in the period phase, as the endometrium dissolves and ‘falls’ out, these foci cannot ‘fall’ and simply become inflamed. They cause foci of local inflammation, resulting in severe pain during periods and during intercourse. If they enter the interior of the ovary, as they bleed, they cause collection of dark blood. These are the ‘chocolate’ cysts of the ovaries, which can be seen on the ultrasound and raise the suspicion of the disease. The remaining foci may be small spots and not visible on the ultrasound.

Endometriosis is more common in peoples and societies with an increased standard of living. The reason is not clear, perhaps because in the Third World, people have more important problems (germs, parasites, tuberculosis) and their body considers it a ‘luxury’ to fight endometrial cells.

How is the diagnosis made?

The ultrasound will only show chocolate ovarian cysts. However, there may be diffuse endometriosis without cysts in the ovaries, this will not be seen by ultrasound. A clear diagnosis (and simultaneous treatment) is made only with an operation called laparoscopy.

Does endometriosis cause damage?

First of all, the local inflammation causes pain – during periods, during intercourse, even during defecation. If endometriosis progresses—and it usually does gradually—there will be diffuse adhesions and more pain.

In addition, in the early stages of the disease, the body mobilizes antibodies and chemicals to fight inflammation. These damage and create a hostile environment for eggs, sperm and embryos. So, endometriosis, even in its initial manifestation, causes infertility. When the disease spreads, adhesions can further block the fallopian tubes and aggravate the problem.

How is the treatment done?

The treatment is the destruction of the foci by diathermy in the operating theatre (laparoscopy). Then, injections usually follow for a few months, once every month. These aim to eradicate any remaining tiny foci. With this combined treatment the pain will stop. If the problem is not the pain but the fertility, a wait is required. If further waiting and trying does not lead to conception, the couple should undergo IVF treatment.

Dermoid cyst – Teratoma

This is a fairly common benign cyst that occurs on the ovary. It is the most common form of benign ovarian neoplasm and usually appears between the ages of 20 and 40 – however, they are found in infancy as well as in the elderly. In 15%, there may be cysts in both ovaries at the same time.

It usually causes no symptoms and is detected during a routine ultrasound scan.

Inside it presents a messy image, which we medically describe as “mixed echogenicity”, i.e. solid and cystic elements mixed. This is because the cyst originates from primordial embryonic cells that are present in the ovaries from birth. For reasons we do not know, at some point these cells begin to multiply (in a benign way) and at the same time differentiate into different types of cells (cartilage cells, bone cells, hair cells, nerve cells), as the primordial cell would do in our embryonic life. .

So the cyst is formed with these mixed cell populations – however irregularly – it does not make a new embryo but a rather disgusting cyst: the teratoma. But it is benign in contrast to the rare teratocarcinoma.

The dermoid cyst must be removed because it will gradually grow up to 10-12 cm size, cause pain, affect the function of the ovary and future fertility.