An ovarian cyst is a fluid-filled sac that develops on or inside an ovary. These cysts are common and often go unnoticed. For women trying to conceive, a diagnosis raises questions, but in a majority of cases, having an ovarian cyst does not prevent conception. Whether a cyst affects your ability to get pregnant depends on the specific type of cyst you have.
Ovarian Cysts and Conception: The Direct Answer
The majority of ovarian cysts are temporary and a normal part of the reproductive cycle. These are known as functional cysts, and they form because of the usual hormonal fluctuations that occur each month. Functional cysts indicate that the processes necessary for fertility are actively taking place.
There are two primary types of functional cysts: follicular cysts and corpus luteum cysts. A follicular cyst forms when the follicle fails to rupture and release the egg at ovulation. The corpus luteum cyst forms after the egg is released, when the remaining follicle seals up and fills with fluid. Both types are benign, short-lived, and typically resolve spontaneously within one to three menstrual cycles.
Because functional cysts are a temporary outcome of a working menstrual cycle, they rarely interfere with ovulation or conception. Most women with this common type of cyst can conceive naturally. The problem cysts, which are less common, are classified as pathological, meaning they are not related to the normal cycle.
Cysts That Actively Interfere with Fertility
Pathological cysts are growths that arise from abnormal cell development within the ovary, and certain types are linked to conditions that impede conception. The most problematic for fertility are endometriomas, which are cysts caused by endometriosis. These are often called “chocolate cysts” because they contain old, dark blood from the ectopic endometrial tissue.
Endometriomas disrupt fertility by causing inflammation in the pelvic environment. This chronic inflammation can negatively affect egg quality and may interfere with the fallopian tubes’ ability to capture the released egg. Furthermore, endometriosis can create scar tissue and adhesions, which physically distort the reproductive anatomy and block the path of the egg and sperm.
Another category of cysts that complicate conception are the numerous small cysts associated with Polycystic Ovary Syndrome (PCOS). The challenge to fertility comes not from the cysts themselves, but from the underlying hormonal imbalance that causes them. High levels of certain hormones prevent the ovaries from releasing an egg, leading to anovulation. Since successful conception requires regular ovulation, the resulting irregular menstrual cycles are the primary barrier to pregnancy.
Other pathological growths, like dermoid cysts (teratomas), are not hormonal but can still indirectly affect fertility. Dermoid cysts contain various tissues, such as hair or skin, and can grow quite large. While the cyst itself does not interfere with the egg-sperm union, surgical removal may be necessary if it becomes too large or symptomatic. Any surgery performed on the ovary carries a small risk of reducing the ovarian reserve.
Managing Cysts During Pregnancy
If you conceive with an existing ovarian cyst, the mass will be closely monitored throughout the pregnancy, usually via routine ultrasound scans. The majority of cysts found in early pregnancy, particularly functional ones, will resolve on their own. This spontaneous resolution is often complete by the end of the first trimester or early second trimester.
In a small number of cases, a cyst may persist or grow, raising concerns about complications. The most serious risks are ovarian torsion and rupture, both of which cause acute, severe abdominal pain and require emergency intervention. Ovarian torsion occurs when the cyst causes the ovary to twist around its blood supply, cutting off circulation.
For persistent cysts that are large (over 5 to 6 centimeters), appear complex on ultrasound, or are causing severe symptoms, surgical removal may be considered. Surgeons prefer to delay any non-emergency operation until the second trimester, specifically between 14 and 23 weeks. This timing minimizes the risk of miscarriage associated with first-trimester surgery and avoids the risk of preterm labor associated with third-trimester procedures.