Ovarian cysts are fluid-filled sacs that develop on or inside an ovary. They are a common occurrence and often do not cause any symptoms, frequently being discovered incidentally during routine examinations. While the presence of an ovarian cyst can raise concerns, particularly regarding fertility, most are harmless and do not prevent pregnancy.
Types of Ovarian Cysts and Their Impact on Fertility
Ovarian cysts fall into two categories: functional cysts and pathological cysts. Functional cysts are the most common type and form as a normal part of the menstrual cycle. These include follicular cysts, which develop when a follicle fails to release an egg, and corpus luteum cysts, which form after an egg is released but the sac reseals and fills with fluid. These functional cysts are benign and do not interfere with a woman’s ability to conceive. Their formation indicates that the ovaries are functioning as expected in preparation for ovulation.
Pathological cysts arise from abnormal cell growth and are less common. Examples include dermoid cysts, which can contain various tissues like hair or skin, and cystadenomas, which are fluid-filled growths that can become quite large. These types of cysts do not affect fertility unless their size requires surgical removal.
Certain pathological cysts and underlying conditions can affect fertility. Endometriomas, often called “chocolate cysts,” form when tissue similar to the uterine lining grows on the ovaries, potentially causing inflammation, scarring, and affecting reproductive function. Polycystic ovary syndrome (PCOS) is another condition where numerous small follicles accumulate on the ovaries, leading to hormonal imbalances that disrupt regular ovulation, making it more challenging to conceive. The small cysts in PCOS are not typically removed, but the hormonal issues they signify can directly impede fertility by preventing egg release.
Conceiving with an Ovarian Cyst
Conceiving with an ovarian cyst is often possible, depending on its type and size. Many cysts, especially functional ones, resolve on their own within a few menstrual cycles, requiring no intervention before conception. However, if a cyst is persistent, causes symptoms, or if there is a history of fertility issues, medical evaluation is recommended.
Diagnosis typically begins with a pelvic examination and a pregnancy test to rule out pregnancy. An ultrasound is the primary imaging tool used to identify cysts, determine their location, and whether they are fluid-filled or solid. For cysts with benign features (e.g., thin-walled, unilocular, smooth-bordered, under 10 cm), a “watchful waiting” approach with serial ultrasounds may be recommended.
Medical interventions before conception vary based on the cyst’s characteristics. Hormonal birth control may be prescribed for functional cysts to help regulate the menstrual cycle and prevent new cyst formation. If a cyst is large, causes pain, or is suspected to be a specific type of pathological cyst that might interfere with fertility, surgical removal might be considered. This could involve laparoscopic surgery (minimally invasive) or, for larger or complex cysts, a laparotomy. Consulting a healthcare provider is important for personalized advice and the most appropriate management strategy to support fertility goals.
Ovarian Cysts During Pregnancy
Ovarian cysts can be discovered during pregnancy, often incidentally during routine ultrasounds, as pre-existing conditions or new formations. The most common type found in early pregnancy is the corpus luteum cyst, which plays a role in producing hormones to support the early stages of pregnancy until the placenta develops. These cysts typically resolve spontaneously by 14 to 20 weeks.
Monitoring of cysts during pregnancy typically involves serial ultrasounds to track their size and characteristics. Most ovarian cysts found during pregnancy are benign and do not cause complications. However, rare complications can include rupture (where the cyst breaks open) or torsion (where the ovary twists on its blood supply), causing severe pain. Very large cysts might also obstruct the birth canal, potentially complicating delivery.
Management during pregnancy is largely conservative, with observation preferred unless complications arise. If a cyst is symptomatic, grows rapidly, or shows suspicious features, surgical removal may be considered, usually during the second trimester (16-23 weeks) to minimize risks to the pregnancy. Such surgery is typically done laparoscopically, though a traditional abdominal incision may be necessary for very large or complex cysts. The majority of ovarian cysts in pregnancy do not pose a threat and resolve without intervention.