Ovarian cysts are fluid-filled sacs that can form on or inside an ovary. They are common and often present without noticeable symptoms. A frequent concern is whether these cysts affect a woman’s ability to conceive. This article explores their relationship with fertility.
Understanding Ovarian Cysts
Ovarian cysts are broadly categorized into two main types: functional and pathological. Functional cysts are the most common, forming as a normal part of the menstrual cycle. Follicular cysts develop when the follicle containing an egg fails to rupture and release the egg during ovulation, causing fluid to accumulate. Corpus luteum cysts form after an egg has been released, if the opening where the egg came from becomes blocked and fluid builds up. These functional cysts are generally benign, often resolving on their own within a few menstrual cycles.
Pathological cysts are not related to the normal menstrual cycle and arise from abnormal cell growth. Endometriomas are cysts filled with old blood that form when endometrial tissue grows on the ovary. Dermoid cysts, also known as teratomas, contain various tissues such as hair, skin, or fat, as they develop from germ cells. Cystadenomas grow on the ovarian surface and can be filled with watery or mucous fluid, sometimes growing quite large.
How Ovarian Cysts Can Affect Fertility
The impact of an ovarian cyst on fertility depends on its type, size, and underlying cause. Most ovarian cysts, especially functional ones, do not interfere with a woman’s ability to become pregnant. These common cysts usually disappear without intervention and do not disrupt ovulation.
However, certain types of cysts or related conditions can pose challenges to fertility. Endometriomas, often called “chocolate cysts,” are strongly linked to endometriosis, a condition where uterine-lining-like tissue grows outside the uterus. These cysts can distort ovarian anatomy, form scar tissue (adhesions) that may block fallopian tubes, and contribute to pelvic inflammation, which can negatively affect egg quality and reproductive function.
Polycystic ovary syndrome (PCOS) is another condition frequently associated with ovarian cysts, though the “cysts” in PCOS are actually numerous small follicles that do not mature or release an egg. PCOS involves hormonal imbalances that prevent regular ovulation, a primary cause of infertility. In women with PCOS, the ovaries develop many small fluid-filled sacs because eggs are not released, leading to irregular or absent periods and making conception difficult. PCOS is considered the most common cause of anovulatory infertility.
Large cysts, regardless of their type, can physically impede ovulation or obstruct the fallopian tubes. Very large cysts also carry a risk of ovarian torsion, where the ovary twists on its blood supply, potentially damaging ovarian tissue. Additionally, surgical removal of some cysts, particularly large ones or endometriomas, can inadvertently reduce ovarian reserve. This impact on ovarian reserve, measured by markers like Anti-Müllerian Hormone (AMH), reflects the remaining egg supply.
Diagnosis and Treatment Approaches
Diagnosing ovarian cysts typically begins with a pelvic examination. The primary diagnostic tool is an ultrasound, allowing doctors to assess the cyst’s size, location, and characteristics, such as whether it is fluid-filled or solid. Blood tests may be performed, particularly if there is a concern about malignancy.
Treatment approaches vary based on the cyst type, size, symptoms, and fertility desires. For many small, functional cysts, a “watchful waiting” approach is common, as these cysts often resolve on their own within a few months. Regular follow-up ultrasounds may be recommended.
Medication may be used to manage symptoms or address underlying conditions. Hormonal medications, such as birth control pills, can be prescribed to prevent new functional cysts by suppressing ovulation. For conditions like PCOS, medications regulating ovulation or addressing hormonal imbalances are often part of the treatment plan to improve fertility.
Surgical intervention is considered when cysts are large, causing persistent symptoms, or if there is a concern about malignancy or their impact on fertility. Laparoscopic surgery, a minimally invasive “keyhole” procedure, is often preferred for removing ovarian cysts. This technique involves small incisions in the abdomen, allowing the surgeon to remove the cyst while striving to preserve as much healthy ovarian tissue as possible. This fertility-preserving approach is particularly important for women who wish to conceive. In rare cases, if a cyst is very large or complex, a laparotomy (open surgery with a larger incision) might be necessary.