Cysts are sacs of tissue that can form in the body. They may contain air, fluids, or semi-solid material. While cysts can be concerning, understanding their connection to conception is important.
Understanding Ovarian Cysts
Ovarian cysts are fluid-filled sacs that develop on or within one or both ovaries. These are a common occurrence, especially during a woman’s reproductive years, and most are harmless.
Functional cysts are the most frequent type, arising from the normal menstrual cycle. Follicular cysts form when a follicle fails to release an egg and fills with fluid. Corpus luteum cysts develop if a follicle releases the egg but then reseals and accumulates fluid.
Pathological cysts include endometriomas, which are filled with menstrual blood and indicate endometriosis. Dermoid cysts (teratomas) can contain various tissues like hair, skin, or teeth. Polycystic ovaries, often associated with Polycystic Ovary Syndrome (PCOS), involve multiple small follicles that do not mature or release eggs.
How Ovarian Cysts Can Affect Fertility
While many functional cysts typically do not impair fertility and often resolve, certain types of ovarian cysts can interfere with conception. The impact depends on the cyst type, its size, and the underlying condition causing it.
One mechanism involves hormonal imbalances, particularly with cysts related to Polycystic Ovary Syndrome (PCOS). PCOS is characterized by higher levels of male hormones (androgens) and insulin resistance, which can disrupt the normal maturation and release of eggs (ovulation). The ovaries in women with PCOS may contain many small, underdeveloped follicles, making regular ovulation difficult or absent, which directly impacts the ability to get pregnant naturally.
Physical obstruction or damage can also occur with certain cysts. Large cysts, including endometriomas, can physically block fallopian tubes, preventing the egg and sperm from meeting. Endometriomas can also distort the anatomy of the ovaries or damage egg quality and ovarian reserve due to the presence of endometrial tissue outside the uterus. Dermoid cysts, when they grow large, can compress or damage ovarian tissue, potentially reducing egg production and affecting egg quality.
Inflammation is another factor, particularly with endometriomas. These cysts can create a hostile pelvic environment due to chronic inflammation caused by the trapped menstrual blood and the body’s immune response to it. This inflammation can impair tubal function, alter sperm motility, and affect the receptivity of the uterine lining for embryo implantation.
Diagnosis and Treatment Options
Ovarian cysts are discovered during a pelvic exam or through imaging tests like a pelvic ultrasound. An ultrasound helps determine the cyst’s size, location, and whether it is fluid-filled or solid. Blood tests, such as a CA 125 test, may be ordered if malignancy is a concern or if the cyst appears solid; however, elevated CA 125 levels can also indicate non-cancerous conditions like endometriosis. A pregnancy test is often performed to rule out early pregnancy, as corpus luteum cysts are normal during gestation.
Treatment approaches vary based on the cyst’s type, size, symptoms, and the woman’s age. For smaller, asymptomatic, fluid-filled cysts, a “watchful waiting” approach is common, involving follow-up ultrasounds to monitor changes. Hormonal birth control may be prescribed to prevent the formation of new functional cysts by suppressing ovulation, though it does not typically shrink existing ones.
Surgical removal, known as a cystectomy, is often recommended for larger cysts, those causing symptoms, or those suspected of affecting fertility. This is performed via laparoscopy, a minimally invasive procedure using small incisions and a camera, which leads to quicker recovery. For very large or potentially cancerous cysts, a laparotomy, involving a larger abdominal incision, might be necessary. For fertility issues related to PCOS, management includes lifestyle changes like diet and exercise, and medications like metformin or ovulation-inducing drugs like clomiphene citrate or letrozole to promote regular ovulation.
Conceiving with Ovarian Cysts and After Treatment
Many women with ovarian cysts can still achieve pregnancy, either naturally or with medical assistance. Functional cysts, being a normal part of the menstrual cycle, do not prevent conception and often resolve without intervention. Even with certain pathological cysts like dermoid cysts and cystadenomas, fertility is unaffected unless they become very large.
After successful treatment of fertility-impairing cysts, such as surgical removal of endometriomas, the likelihood of conception can improve. If surgery is performed, surgeons aim to preserve ovarian tissue to maintain fertility, removing only the cyst and leaving the ovary intact. If one ovary needs to be removed, the remaining ovary can still release eggs and hormones, making pregnancy possible, though it might be more challenging. Ovulation and menstrual periods normalize within a few months post-surgery, with many women conceiving within this timeframe.
For those where cysts or underlying conditions continue to affect fertility, assisted reproductive technologies like ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF) may be considered. Ovulation induction medications help stimulate egg development, while IVF involves retrieving eggs and fertilizing them outside the body. Consult a healthcare provider for personalized advice and management to optimize chances of conception.