A Novel Case of Pregnancy Alongside Endometriosis, A Case Report and Review of the Literature

•Endometriosis is a gynaecological condition commonly linked to infertility and pregnancy complications, yet some cases, like ours, show successful pregnancy without major complications. •The absence of endometriomas in our patient may explain the lack of severe complications, unlike cases where endometriomas caused ileal perforation, abscess formation, and emergency delivery. •Prior surgery for endometriosis has been associated with higher risks of preterm birth and placenta previa, but our patient had no history of surgery, which may have contributed to a smoother pregnancy. •Studies report increased risks of preeclampsia and gestational diabetes in women with endometriosis, though our case suggests that the absence of endometriomas may reduce these risks.

•Endometriosis is a chronic gynaecological condition affecting around 10% of women world-wide, it is characterised by ectopic endometrial tissue. •It is associated with chronic pelvic pain, dysmenorrhea, and infertility. •Endometriosis has been linked to adverse pregnancy outcomes, including preterm birth and placental complications, though not all cases lead to such issues. •This case highlights a patient with concurrent PCOS, longstanding dysmenorrhea, and MRI findings indicative of endometriosis without endometriomas. •The findings emphasise the importance of early diagnosis and individualised management to improve reproductive outcomes and symptom control. Case Presentation •A 26-year-old female presented with features of PCOS, including oligomenorrhoea, facial acne, and an elevated LH/FSH ratio, along with a 12-year history of dysmenorrhea unrelieved by analgesics, radiating to the back, and associated with diarrhea. •MRI pelvis with IV contrast revealed an anteverted, retroflexed uterus (2.6×3.8×5.3 cm), a dark T2W1 band along the posterior torus uterus, low T2 signal outlining the serosal surface, and thickening of the bilateral round ligaments, consistent with endometriosis but no endometriomas. •The patient had been on OCPs but discontinued them to conceive, starting prenatal folic acid and previously using Visanne (dienogest) for symptom management of endometriosis. •Laboratory results showed FSH 8.3 mIU/mL, LH 49.8 mIU/mL, and prolactin 18.7 ng/mL, indicating hormonal imbalances related to PCOS. •Despite the coexistence of PCOS and endometriosis-related symptoms, the patient remained stable and reported no complications during pregnancy. •She continues to be under regular follow-up, reinforcing the importance of individualised management in patients with concurrent PCOS and endometriosis.

•This case highlights a successful pregnancy in a patient with both PCOS and endometriosis, suggesting that the absence of endometriomas may reduce pregnancy complications. •Individualised management and close monitoring remain crucial for optimising outcomes in similar cases. Noor Elabd 2,Lara Samhan 2, Sara Samhan 2, Alhanof Althowaini 2, Sadia Malick 1 1 King Faisal Specialist Hospital and Research Center, Riyadh, KSA 2College of Medicine, Alfaisal University, Riyadh, KSA A Novel Case of Pregnancy Alongside Endometriosis, A Case Report and Review of the Literature

UGM0103

A 26-year-old female with a 12-year history of dysmenorrhea and PCOS symptoms (oligomenorrhea, acne, elevated LH/FSH) sought pregnancy after discontinuing oral contraceptives. MRI revealed an anteverted, retroflexed uterus with features of endometriosis— including a dark T2W1 band and thickened round ligaments—but no endometriomas. She began treatment with Visanne and folic acid supplementation. Currently, the patient remains pregnant without complications. This case underscores that uncomplicated pregnancies are possible in women with endometriosis, particularly in the absence of endometriomas.

To present a unique case of a 26-year-old female with endometriosis absent of endometriomas who achieved an uncomplicated pregnancy and to explore its implications for managing endometriosis-related fertility. 010 20 30 40 50 60 LH (IU/L) FSH (IU/L) Prolactin (ng/mL) Patient Value Normal Range (Median) Fig. 1: Axial T2-weighted MRI of the pelvis showing a distinct area of low T2 signal intensity (arrow) along the posterior aspect of the uterus. No endometriomas are identified. Fig. 3: Sagittal T2-weighted MRI of the pelvis demonstrating a low T2 signal band along the posterior uterine surface, with no visible endometriomas. The bladder is seen anteriorly, and the uterus appears anteverted and retroflexed. Fig. 2 Explanation: •FSH: The patient's FSH (8.3 IU/L) is comparable to the normal median (~8 IU/L). •LH: The patient’s LH (49.8 IU/L) is significantly elevated compared to the normal median (~6 IU/L), consistent with PCOS. •Prolactin: The patient's prolactin (18.7 ng/mL) is slightly above the normal median (~12 ng/mL) but remains near the upper limit of normal.