In Vitro Fertilization (IVF) is a widely used treatment for infertility, involving stimulating the ovaries to produce multiple eggs for retrieval and fertilization in a lab. The process begins with hormonal screening and ultrasound monitoring, which frequently detects ovarian cysts. These fluid-filled sacs are extremely common in women undergoing fertility assessments. While a cyst on a preliminary ultrasound does not automatically stop an IVF cycle, it requires careful evaluation. The decision to proceed depends entirely on the cyst’s type, size, and hormonal activity.
Understanding Different Types of Ovarian Cysts
Ovarian cysts are classified into two categories based on their origin and behavior, which determines management during fertility treatment.
Functional Cysts
Functional cysts develop as a normal, temporary part of the menstrual cycle. Follicular cysts form when a dominant follicle fails to rupture and continues to grow. Corpus luteum cysts develop from the ruptured follicle after ovulation and may persist, sometimes producing progesterone that delays the next period. These cysts typically resolve on their own within one to two months, often requiring only observation.
Pathological Cysts
Pathological cysts are growths unrelated to the normal menstrual cycle and are more persistent. Endometriomas, or “chocolate cysts,” are caused by endometriosis tissue growing on the ovary and filling with old blood. These cysts are concerning because they are associated with an underlying disease process and can potentially reduce ovarian reserve. Dermoid cysts, or teratomas, are also pathological, forming from embryonic cells. Pathological cysts require closer assessment because they do not usually disappear without intervention and can affect ovarian function.
How Cysts Influence IVF Treatment Protocols
Cysts interfere with the IVF process primarily through hormonal disruption and physical obstruction, especially if they are large or hormonally active. Functional follicular cysts can produce estrogen, prematurely elevating blood estradiol levels at the start of the cycle. This hormonal imbalance interferes with the pituitary suppression needed for controlled ovarian hyperstimulation (COH). This interference can lead to an asynchronous follicular response, where the cyst grows disproportionately, potentially compromising the quality and number of eggs retrieved.
A large cyst can also physically obstruct the ovary, reducing the space available for new, healthy follicles during stimulation. Furthermore, a massive cyst can impede the egg retrieval procedure by obscuring the ovary or making needle access difficult or risky. Larger or persistent cysts, such as large endometriomas, may necessitate a more complicated and costly stimulation protocol. Patients with baseline cysts sometimes require higher doses of gonadotropins to achieve an adequate ovarian response.
Medical Management of Cysts During IVF
Fertility specialists employ several strategies to manage cysts and allow the IVF cycle to proceed successfully. For a hormonally active functional cyst detected during the baseline ultrasound, the specialist may recommend hormonal suppression. This often involves taking oral contraceptive pills for a short time to quiet the ovary and encourage the cyst to shrink or resolve naturally before stimulation begins.
A common and direct approach is transvaginal ultrasound-guided cyst aspiration, where a fine needle drains the fluid from the cyst. This minimally invasive procedure is typically performed before ovarian stimulation to eliminate the cyst’s hormonal interference and physical bulk. The fluid may also be sent for cytological analysis, though this is rare for simple cysts.
Small, simple cysts, particularly those less than 15 millimeters or those without hormonal activity, are often monitored closely throughout the stimulation phase. The specialist tracks the cyst’s size and hormone levels to ensure it does not negatively impact the growth of new follicles. If managed successfully, the IVF cycle can proceed without significant delay or compromise.
Conditions Requiring IVF Cycle Delay or Cancellation
While most cysts can be managed, specific high-risk scenarios require the physician to postpone or cancel the IVF cycle entirely. The most serious concern is when a cyst exhibits suspicious characteristics on ultrasound, such as solid components, thick internal walls, or unusual blood flow, suggesting a potential risk of malignancy. In this event, the cycle must be delayed so the cyst can be surgically removed and biopsied before fertility treatments are initiated.
Acute medical issues, such as rapid growth, sudden severe pain, or signs of ovarian torsion, also necessitate immediate medical attention and cycle cancellation. Ovarian torsion, where the ovary twists around its blood supply, is a surgical emergency exacerbated by ovarian enlargement during stimulation. Furthermore, a cyst that is too large or poorly positioned to allow safe access to the ovary during egg retrieval will lead to cancellation to avoid complications.
In some cases, pathological cysts like large endometriomas may be surgically removed prior to stimulation to improve egg yield or reduce infection risk. However, surgery can potentially reduce the ovarian reserve. The decision to operate is a careful balance between the cyst’s risk and the potential loss of healthy ovarian tissue. If a cyst causes a poor response to stimulation drugs, or if high estrogen levels resist suppression, the cycle may be canceled to allow for a better-planned attempt later.