Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries and are common in women during their reproductive years. Having an ovarian cyst generally does not prevent pregnancy, but the impact depends on the specific type present. Most cysts are harmless and temporary. However, certain types of cysts or the underlying conditions that cause them can affect ovulation and conception. Determining the nature of the cyst is the first step in understanding any potential impact on conception.
Understanding Ovarian Cysts
Ovarian cysts are categorized into two major types: functional and pathological. Functional cysts are the most frequent type, arising directly from the normal processes of the menstrual cycle. These cysts are physiological, meaning they result from the ovary’s routine function, and they typically resolve without medical intervention.
Functional cysts include follicular cysts (when a follicle fails to rupture and release an egg) and corpus luteum cysts (which develop after ovulation when the follicle sac reseals and fills with fluid or blood). These cysts tend to be small and disappear spontaneously, usually within one to three months. Pathological cysts, in contrast, result from abnormal cell growth and are not connected to the normal menstrual cycle. Examples include endometriomas, dermoid cysts, and cystadenomas, which often require monitoring or treatment because they do not resolve on their own.
The Impact of Cysts on Conception
The effect of an ovarian cyst on conception is determined by its classification. Functional cysts, which form as part of the monthly cycle, do not cause infertility. Their presence is often a sign that the hormonal functions necessary for fertility are taking place.
Pathological cysts can interfere with fertility depending on their size and type. Endometriomas, often called “chocolate cysts,” are linked to endometriosis, where tissue similar to the uterine lining grows outside the uterus. These cysts can impair fertility by causing inflammation, forming scar tissue, or distorting the pelvic anatomy, which can block a fallopian tube. Dermoid cysts and cystadenomas are generally not linked with infertility unless they grow very large or require surgery that may affect the ovary’s healthy tissue.
Polycystic Ovary Syndrome (PCOS) presents a more significant fertility barrier. This hormonal disorder is characterized by many small cysts on the ovaries. In PCOS, the cysts are a symptom of a systemic issue that prevents regular ovulation. The core problem is a hormonal imbalance that disrupts the release of an egg, making conception difficult. While a simple cyst rarely blocks conception, an underlying condition like PCOS or the inflammation caused by an endometrioma can reduce the chances of a natural pregnancy.
Treatment Options While Trying to Conceive
Management of an ovarian cyst while seeking pregnancy requires a careful approach to preserve fertility. For small, asymptomatic cysts that appear simple on ultrasound, “watchful waiting” is the common initial strategy. This involves monitoring the cyst with follow-up ultrasounds to ensure it resolves spontaneously, which is the expected outcome for most functional cysts.
If a cyst is large, complex, persistent, or suspected to be an endometrioma or at high risk for complications like ovarian torsion, surgical removal may be recommended before attempting conception. Surgeons aim to use minimally invasive procedures, such as laparoscopy, to remove the cyst while preserving as much healthy ovarian tissue as possible. Preserving the ovary is necessary to maintain the person’s ovarian reserve and future fertility prospects.
Following laparoscopic cyst removal, individuals are typically advised to wait about four to six weeks before attempting to conceive, allowing the body to heal completely. While hormonal treatments like birth control pills are sometimes used to manage cysts and prevent their recurrence, these medications must be discontinued when trying to get pregnant. The treatment plan is always individualized, balancing the need to remove a problematic cyst with the goal of minimizing any potential impact on the ability to conceive.
Ovarian Cysts Discovered During Pregnancy
It is common for an ovarian cyst to be detected during routine first-trimester prenatal ultrasounds, occurring in up to 4% of all pregnancies. The majority of these masses are benign and consist of functional cysts, such as the corpus luteum, which is necessary for early pregnancy hormonal support. Most ovarian cysts found early in pregnancy resolve on their own, often by 16 to 20 weeks of gestation.
For simple cysts that are smaller than five to six centimeters and have benign features, no further follow-up is usually needed during the pregnancy. Close monitoring with serial ultrasounds is necessary for persistent cysts, those larger than six centimeters, or those with a complex appearance. The primary concern with a cyst during pregnancy is the risk of complications, including rupture, hemorrhage, or ovarian torsion, where the ovary twists on its pedicle.
If a cyst requires surgical removal due to a high risk of complication or suspicion of malignancy, the procedure is typically scheduled during the second trimester, between 16 and 20 weeks. This timing minimizes the risk of miscarriage associated with surgery in the first trimester and avoids the technical difficulties of operating on a much larger uterus later in the pregnancy. Surgery is generally avoided unless the cyst poses an immediate threat to the mother’s health or the pregnancy.