Ovarian cysts are common fluid-filled sacs that can develop on or inside the ovaries. While many of these cysts are harmless and resolve without intervention, some types can potentially affect a woman’s ability to conceive. This article explores the nature of ovarian cysts and their potential connection to fertility.
Understanding Ovarian Cysts
Ovarian cysts are fluid-filled sacs that form on or within an ovary. They are common in women of reproductive age, with many individuals developing at least one without knowing it. Cysts are broadly categorized into two main types: functional and pathological.
Functional cysts are the most frequent type, developing as a normal part of the menstrual cycle. Follicular cysts form when a follicle, which usually releases an egg during ovulation, fails to rupture and continues to grow with fluid. Corpus luteum cysts develop after an egg has been released, if the follicle reseals and fills with fluid or blood. These functional cysts are benign, often cause no symptoms, and usually disappear on their own within a few menstrual cycles.
Pathological cysts are less common and result from abnormal cell growth, unrelated to the menstrual cycle. Examples include endometriomas, dermoid cysts (also known as teratomas), and cystadenomas. Endometriomas are cysts filled with old blood, often called “chocolate cysts,” and are associated with endometriosis. Dermoid cysts can contain various tissues like hair, skin, or teeth, while cystadenomas develop from the ovary’s surface cells and may be filled with watery or mucous material. Most pathological cysts are benign, but some can be cancerous, particularly in postmenopausal women.
How Ovarian Cysts Can Impact Fertility
While many ovarian cysts do not affect fertility, certain types can interfere with the ability to become pregnant. The impact often depends on the cyst’s type, size, and its underlying cause.
Cysts can affect fertility through hormonal imbalance, as seen in Polycystic Ovary Syndrome (PCOS). PCOS is a hormonal disorder characterized by many small cysts on the ovaries, irregular periods, and elevated androgen levels. These hormonal disruptions prevent regular ovulation, meaning eggs are not consistently released, which directly hinders conception.
Physical obstruction is another mechanism, particularly with larger cysts or endometriomas. Large cysts can distort the anatomy of the ovary or physically block the fallopian tubes, preventing the egg from traveling to the uterus or sperm from reaching the egg for fertilization. This physical interference can make natural conception difficult.
Inflammation and adhesions are frequently associated with endometriomas, which are cysts caused by endometriosis. Endometriosis involves tissue similar to the uterine lining growing outside the uterus, often on the ovaries and fallopian tubes. These growths can lead to chronic inflammation and the formation of scar tissue, known as adhesions, which can bind pelvic organs together. Adhesions can deform the ovaries and fallopian tubes, impeding egg release or transport.
Some cysts can also directly interfere with the normal ovulatory process. Even if not associated with a condition like PCOS, a large cyst can physically disrupt follicle development and egg release. This disruption can lead to irregular or absent ovulation, making it harder to time intercourse for conception or to achieve pregnancy.
Diagnosis and Management
Diagnosing ovarian cysts begins with a pelvic exam, where a healthcare provider may feel a lump near the ovary. The primary diagnostic tool is an ultrasound scan, often performed transvaginally, which provides detailed images of the ovaries and determines the cyst’s size, location, and whether it is fluid-filled or solid. A pregnancy test is also performed to rule out ectopic pregnancy, which can present with similar symptoms. Blood tests may be ordered to assess hormone levels or check for tumor markers if malignancy is a concern.
When fertility is a concern, management approaches are tailored to the cyst type and its potential impact. Functional cysts often require observation, as they resolve on their own within a few months. For cysts associated with hormonal imbalances, such as those in PCOS, medical management might involve medications to regulate the menstrual cycle and induce ovulation. Hormonal contraceptives, while not shrinking existing cysts, can help prevent new functional cysts from forming.
Surgical intervention, often via laparoscopy, may be recommended for problematic cysts that interfere with conception. This minimally invasive procedure involves small incisions and the use of a camera to remove cysts, such as large, persistent, or symptomatic cysts, or endometriomas. The goal of surgery in fertility-focused cases is to remove the cyst while preserving as much healthy ovarian tissue as possible to maintain ovarian function and improve the chances of pregnancy.