Ovarian cysts are common, fluid-filled sacs that can develop on or inside the ovaries during a person’s reproductive years. While often benign and asymptomatic, a frequent concern for those trying to conceive is whether these cysts can hinder pregnancy. Understanding the different types of ovarian cysts and their potential effects is important for addressing this worry.
Understanding Ovarian Cysts
Functional cysts are the most common type, arising as a normal part of the menstrual cycle. Follicular cysts develop when a follicle fails to rupture and release an egg, growing and filling with fluid. Corpus luteum cysts form after an egg is released, if the follicle fills with fluid or blood. These functional cysts are usually harmless, often resolve on their own within two to three menstrual cycles, and generally do not cause symptoms.
Other types of cysts, known as pathological cysts, are not directly related to the menstrual cycle. Endometriomas, or “chocolate cysts,” occur when uterine lining-like tissue grows on the ovary, containing thick, dark blood. Dermoid cysts form from reproductive cells and can contain various tissues like hair or skin. Cystadenomas develop from cells on the ovary’s surface and can grow large, filled with watery or mucous material. Polycystic Ovary Syndrome (PCOS) is a hormonal condition characterized by ovaries containing many small, underdeveloped follicles, often referred to as cysts, due to irregular or absent ovulation.
Mechanisms of Fertility Impact
While many ovarian cysts do not affect fertility, certain types can interfere with conception. One mechanism is the disruption of ovulation. In PCOS, hormonal imbalances lead to irregular or absent ovulation, preventing the normal maturation and release of an egg. Similarly, large or persistent functional cysts can sometimes prevent the ovary from releasing an egg.
Physical obstruction by certain cysts can also impede fertility. Large pathological cysts, such as endometriomas, dermoid cysts, or cystadenomas, might physically block the fallopian tubes or interfere with the egg’s journey. Endometriomas can damage ovarian tissue and cause adhesions, which are scar tissue bands that distort reproductive anatomy. These adhesions can obstruct the fallopian tubes, preventing egg and sperm from meeting or a fertilized egg from reaching the uterus.
Some cysts can create an unfavorable environment for conception. Endometriomas can produce inflammatory substances, potentially affecting egg quality and uterine lining receptivity for implantation. The chronic inflammation associated with endometriosis can also lead to a less hospitable environment for embryo development. While functional cysts generally do not impact fertility, their presence can sometimes be a symptom of underlying hormonal imbalances.
Pathways to Conception with Cysts
For individuals with ovarian cysts trying to conceive, diagnosis is the initial step to identify the cyst’s type, size, and characteristics. Ultrasound, particularly transvaginal ultrasound, is the primary diagnostic tool, providing detailed images. Blood tests, such as hormone levels for PCOS or CA-125 for certain pathological cysts, may also be used.
Management approaches vary depending on the cyst type and its impact on fertility. For most functional cysts, “watchful waiting” is common, as they often resolve on their own. For PCOS, non-surgical management involves lifestyle changes and hormonal therapy, like ovulation induction medications, to regulate cycles and encourage egg release. If medical treatments are unsuccessful, surgical interventions may be considered.
Surgical removal of cysts, known as cystectomy, may be recommended for large, persistent, symptomatic, or suspicious pathological cysts. This procedure aims to remove the cyst while preserving ovarian tissue, which is important for fertility. If natural conception remains challenging, fertility treatments such as ovulation induction or In Vitro Fertilization (IVF) may be pursued. IVF can be beneficial as it bypasses potential issues by fertilizing eggs outside the body.
Cysts During Pregnancy
Ovarian cysts are commonly found during pregnancy, often identified incidentally during early ultrasound scans. The most frequent type is the corpus luteum cyst, a normal and beneficial part of early pregnancy. This cyst forms after ovulation and produces progesterone, a hormone essential for maintaining the uterine lining and supporting early pregnancy.
Most corpus luteum cysts are harmless and typically resolve on their own by the second trimester. Other types of cysts, including dermoid cysts or cystadenomas, can also be present or develop during pregnancy. These are generally monitored with serial ultrasounds to track their size and characteristics.
While most ovarian cysts in pregnancy are benign, some may lead to uncommon complications. These include rupture (cyst bursts) or ovarian torsion (ovary twists around its blood supply). Such complications can cause sudden, severe abdominal pain. In rare cases, surgical intervention might be necessary, typically performed during the second trimester when risks are minimized.