Ovarian cysts are fluid-filled sacs that can develop on or within the ovaries. While many are benign and resolve without intervention, certain types can affect a woman’s ability to conceive. Understanding their impact on reproductive health is important for those concerned about fertility.
Understanding Ovarian Cysts
Ovarian cysts are a common gynecological finding, with most women experiencing at least one in their lifetime. These cysts generally fall into two categories: functional cysts and pathological cysts. Functional cysts are a normal part of the menstrual cycle, while pathological cysts arise from abnormal cell growth and are less common.
The ovaries, two almond-shaped organs on either side of the uterus, are responsible for releasing eggs and producing hormones like estrogen and progesterone. While many ovarian cysts do not cause symptoms, larger cysts or those that rupture or twist can lead to pain, bloating, or changes in menstrual periods.
When Ovarian Cysts May Affect Fertility
Certain types of ovarian cysts, or the underlying conditions that cause them, can have a direct or indirect impact on fertility.
Endometriomas, or “chocolate cysts,” are caused by endometriosis, a condition where uterine-like tissue grows outside the uterus, often on the ovaries. These cysts, filled with menstrual blood, can cause pelvic pain, inflammation, and scarring. This may damage ovarian tissue, reduce ovarian reserve, or block fallopian tubes, making conception difficult. Studies suggest 30-50% of women with endometriosis experience infertility.
Dermoid cysts, or mature cystic teratomas, are another type of cyst that can affect fertility. These cysts form from reproductive cells and can contain various tissues like hair, skin, or even teeth. While benign, large dermoid cysts can compress or damage ovarian tissue, potentially reducing egg production or interfering with egg retrieval during assisted reproductive technologies like IVF. They also carry a risk of ovarian torsion (twisting of the ovary), which can lead to severe pain and, if not treated promptly, loss of the affected ovary, thereby compromising future fertility.
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by many small follicles on the ovaries, irregular periods, and high levels of male hormones (androgens). Although the “cysts” in PCOS are actually underdeveloped follicles that do not release an egg, this condition is a leading cause of anovulatory infertility because it disrupts regular ovulation. The hormonal imbalances associated with PCOS can prevent egg maturation and release, making natural conception challenging for many women.
Ovarian Cysts That Typically Do Not Affect Fertility
Many common ovarian cysts are generally benign and do not impair fertility. Functional cysts are the most prevalent type and are a normal part of the menstrual cycle. These include follicular cysts and corpus luteum cysts. A follicular cyst develops when a follicle, which holds a maturing egg, fails to rupture and release the egg during ovulation, continuing to grow with fluid. These cysts usually resolve on their own within one to three menstrual cycles.
A corpus luteum cyst forms after an egg has been released from its follicle. Normally, the remaining follicle transforms into the corpus luteum, which produces hormones to support a potential pregnancy. If this structure reseals and fills with fluid instead of shrinking, a corpus luteum cyst forms. These cysts are typically harmless, often asymptomatic, and usually disappear on their own without requiring medical intervention or impacting future fertility. The presence of functional cysts often indicates that the ovaries are working as expected.
Diagnosis and Management of Fertility-Related Cysts
Diagnosis often begins with a pelvic examination, where a healthcare provider may feel a lump. An ultrasound, particularly a transvaginal ultrasound, is then commonly used to visualize the cyst, determining its size, location, and whether it is fluid-filled or contains solid components. In some cases, blood tests, such as a CA-125 level, may be performed, especially if there is a concern for malignancy, though this marker is not specific to cancer.
Management approaches for fertility-related cysts vary based on the type, size, and symptoms of the cyst, as well as the woman’s desire for future pregnancy. For PCOS-related anovulation, lifestyle changes like weight loss are often the first recommendation. Medications such as clomiphene or letrozole are frequently prescribed to stimulate ovulation, with metformin sometimes used to improve insulin sensitivity and hormonal balance. If these medications are ineffective, laparoscopic ovarian drilling, a surgical procedure that uses heat or a laser to destroy a small part of the ovary, can lower androgen levels and induce ovulation in some cases.
For endometriomas or large dermoid cysts, surgical intervention may be considered, usually through minimally invasive laparoscopy. This procedure involves small incisions and the use of a thin scope to remove the cyst while aiming to preserve as much healthy ovarian tissue as possible. The goal of such surgery is to remove problematic growths, reduce pain, and improve the chances of conception by restoring normal pelvic anatomy and ovarian function. Post-surgery, careful monitoring and, if needed, assisted reproductive technologies like in vitro fertilization (IVF) may be pursued to optimize fertility outcomes.