Tubo-Ovarian Abscess (TOA) Due to Bilateral Ovarian Endometriomas: Conservative Treatment to Retain Fertility-A Case Report

Objective: To report a case of TOA from bilateral ovarian endometriomas and discuss how fertility may be preserved. Case: A 37-year-old gravida 1/para 0 female underwent treatment for infertility for seven years. Her initial laparoscopy, at age 31, disclosed bilateral ovarian endometriomas (stage IV endometriosis according to the revised classification of the American Society for Reproductive Medicine [r-ASRM]). Ultrasound-guided transvaginal endometrioma aspirations were done on four occasions, and more than 10 attempts at intrauterine insemination (IUI) failed. At age 35, she also developed pelvic inflammatory disease (PID) two days following an IUI procedure. Antibiotics were given and the infected ovarian cysts aspirated. However, the condition became episodic, so laparoscopic intervention with transvaginal ultra-sound guided aspiration was elected to withdraw pus. Once recovered, 10 poststimulatory eggs were harvested. She subsequently conceived with in vitro fertilization (IVF), and a healthy baby was finally delivered vaginally. Conclusions: Up to 25% of infertility patients have ovarian endometriomas. If PID develops, antibiotics are clearly indicated; but surgical drainage of pus may still be needed. We routinely give preservation of fertility high priority, using minimally invasive laparoscopy and transvaginal, ultrasound-guided aspiration. Ovarian function was thus retained for this patient, despite TOA and repeated endometrioma infections.