An ovarian cyst is a fluid-filled sac on or within an ovary. While common, their impact on fertility varies. Understanding different cyst types and their interaction with the reproductive system is important for those considering pregnancy.
Understanding Ovarian Cysts
Ovaries produce small, fluid-filled sacs called follicles each month, which house and release an egg during ovulation. An ovarian cyst forms when a follicle does not behave as expected. Functional cysts, like follicular or corpus luteum cysts, are the most common type and arise from the normal menstrual cycle. A follicular cyst occurs if a follicle fails to rupture and release its egg, growing and filling with fluid. Conversely, a corpus luteum cyst forms if the follicle that released the egg does not shrink, instead filling with fluid or blood. These functional cysts are generally harmless and often resolve on their own within a few menstrual cycles.
Other types of cysts are not directly related to the menstrual cycle. Endometriomas, often called “chocolate cysts,” are associated with endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, including on the ovaries. Dermoid cysts, also known as teratomas, are unique because they can contain various tissues like hair, skin, or even teeth, developing from embryonic cells. Cystadenomas are fluid-filled growths that develop on the surface of the ovary and can become quite large.
How Cysts Influence Conception
Many ovarian cysts do not prevent pregnancy. However, certain types of cysts or underlying conditions can interfere with conception. The primary way some cysts affect fertility is by disrupting ovulation. For example, in Polycystic Ovary Syndrome (PCOS), numerous small follicles develop due to hormonal imbalances, preventing eggs from maturing and releasing regularly. This irregular or absent ovulation directly impacts the ability to conceive naturally.
Large cysts, or those associated with conditions like endometriosis, can also create physical obstructions. Endometriomas, for instance, may lead to inflammation, scarring, or adhesions that can distort the anatomy of the ovaries and fallopian tubes, making it difficult for an egg to be released or for sperm to reach it. Very large cysts might also physically block fallopian tubes or interfere with the ovary’s ability to capture an egg. Some cyst-related conditions can also affect the uterine lining’s receptivity to an embryo. The cyst’s type, size, and any underlying medical conditions are key factors determining its influence on fertility.
Navigating Pregnancy with Cysts
Many ovarian cysts discovered during pregnancy are functional and often resolve spontaneously. The most common type found in early pregnancy is the corpus luteum cyst, which produces progesterone, a hormone necessary for maintaining early pregnancy until the placenta takes over. These cysts usually disappear on their own by the middle of the second trimester.
Ovarian cysts can rarely lead to complications during pregnancy. One potential issue is ovarian torsion, where the ovary twists around its supporting tissues, cutting off blood supply. This causes sudden, severe abdominal pain, nausea, and vomiting. The risk of ovarian torsion is five times higher during pregnancy, particularly between the sixth and fourteenth weeks.
Another rare complication is cyst rupture, which can result in sudden pain and internal bleeding, though the fluid often reabsorbs. While most cysts do not grow significantly, some may enlarge due to hormonal changes, causing discomfort or, rarely, interfering with delivery if very large. Close monitoring through ultrasounds is recommended to track the cyst’s size and characteristics.
Approaches to Fertility with Ovarian Cysts
The approach to managing ovarian cysts when trying to conceive is individualized, depending on the cyst’s type, size, symptoms, and impact on fertility. For functional or small, asymptomatic cysts, a “wait and see” approach is common. Many resolve spontaneously within a few menstrual cycles without intervention.
For fertility challenges linked to Polycystic Ovary Syndrome (PCOS), medical management often involves hormonal medications. Drugs such as clomiphene or letrozole can stimulate ovulation by encouraging the monthly release of an egg. Metformin, typically used for type 2 diabetes, may also be prescribed to help regulate insulin levels, which can improve ovulation in individuals with PCOS.
Surgical intervention may be considered for large, symptomatic, or suspicious cysts, or for conditions like endometriomas that significantly interfere with fertility. Surgeons aim to remove the cyst while preserving healthy ovarian tissue to maintain ovarian function. In cases where other treatments are unsuccessful, assisted reproductive technologies (ART) like in vitro fertilization (IVF) can be an option. While cysts can influence fertility treatment effectiveness, IVF often proceeds, sometimes after cyst aspiration or management. Personalized medical advice is important to determine the most suitable strategy for each individual.