Malhotra Nursing and Maternity Home, Agra, India

TThe patient, a 28-year-old woman, presented with secondary infertility of 5 years duration. Her first child (a daughter now aged 5 years) was delivered normally. At presentation, she complained only of dysmenorrhoea, lower abdominal pain, and backache.

Various diagnostic tests were performed. Screening colour doppler sonosalpingography revealed patent fallopian tubes, a normal uterus, and a normal endometrial canal. However, both ovaries were enlarged and each contained a small hyperechoric mass: 1.6 ¥ 1.6 cm in the right ovary, and 2.5 ¥ 2.5 cm in the left ovary (figures 1, 2).

X-ray of the lumbar spine was inconclusive, but magnetic resonance imaging of the pelvis (see figure 3) revealed the following:
1. Lobulated space-occupying lesion (SOL) in the left ovary suggestive of lipomatous tissue. 2. Focal lesion in the right ovary of hypo- to hyper-intensity on T1- and T2-weighted sequences.

Diagnostic laparoscopy (figures 4, 5) confirmed the enlarged ovaries. The SOL was removed (cystectomy). Tubal patency was established.

figure 1.

figure 2.

1. What is the most likely diagnosis?
   
2. What are the ultrasound characteristics of this condition?
3. How does it cause infertility?
4. What is the ideal management approach (and what precautions should be taken)?
5. What are the prospects for restoring fertility?
   
   

figure 3.

figure 4.

figure 5.

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