OP19.02: Clinical history of recto‐vaginal septa deep infiltrating endometriosis during repeated ovulation induction: a case report

A 31-year-old infertile woman complaining severe dysmenorrhea with bilateral endometrioma and not evidence of recto-vaginal septa deep infiltrating endometriosis (DIE) implants at 3D-transvaginal sonography (3D-TVS) underwent six consecutive IUI cycles with ovulation induction. One month after the last failed stimulated cycle the patient complained severe pelvic pain and needed hospital recovery. At 3D-TVS a large DIE recto-vaginal septa lesion was observed (28 × 10 × 20 mm). She was conservatively managed with analgesic drugs and a 3.75 mg GnRH analogue ampoule was administred i.m. An operative laparoscopy before further assisted reproductive techniques (ART) procedure was planned. The pre-operatively scan showed two enlarged endometriomas but no evidence of the DIE recto-vaginal septa lesion. At laparoscopy, both the endometriomas were removed and a large biopsy of the apparently normal recto-vaginal septa was performed. Endometriosis was reported in all the specimen at histology. The post-operative course was uneventful. At six months follow-up, the patient is symptoms free and to be included in a new ART program. Repeated cycles with ovulation induction might stimulate significant enlargement of deep infiltrating endometriotic lesions. The appearance of a sudden pelvic mass in an endometriotic patient undergoing repeated stimulation should be suspected as a DIE lesion.