Ovarian cysts are common fluid-filled sacs that develop on or inside an ovary, frequently found in women during their reproductive years. While many are harmless and resolve on their own, their presence often raises questions about fertility and the possibility of becoming pregnant.
Conceiving with an Ovarian Cyst
It is generally possible to get pregnant even with an ovarian cyst. Many cysts are benign and do not interfere with ovulation or conception, and their impact on fertility depends on their type, size, and symptoms. Functional cysts, the most common type, are a normal part of the menstrual cycle and rarely affect fertility. However, larger cysts or those causing hormonal imbalances can sometimes make conception more challenging by disrupting ovulation or blocking egg release.
Ovarian Cyst Types and Their Fertility Implications
Ovarian cysts can be broadly categorized, and their effect on fertility varies significantly by type. Functional cysts, including follicular and corpus luteum cysts, typically do not impair fertility. A follicular cyst forms when a follicle fails to rupture and release an egg during ovulation. A corpus luteum cyst develops after an egg is released if the follicle entrance blocks and fluid accumulates. These functional cysts are usually temporary. Other types of cysts, however, can have more direct implications for fertility.
Endometriomas, often called “chocolate cysts,” are associated with endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. These cysts can lead to scarring and inflammation, potentially affecting egg quality and making conception more difficult.
Dermoid cysts, or teratomas, contain various tissues like skin, hair, or even teeth. While generally benign, large dermoid cysts can cause ovarian torsion, a twisting of the ovary that can compromise its blood supply and impact ovarian function, sometimes requiring surgical removal.
Cystadenomas are growths on the surface of the ovary that can become quite large but typically do not affect fertility unless their size causes complications.
Polycystic ovary syndrome (PCOS) is a condition characterized by the presence of many small cysts on the ovaries, irregular periods, and hormonal imbalances. PCOS can significantly affect fertility by disrupting or preventing regular ovulation. Managing the underlying hormonal issues of PCOS is often key to improving fertility outcomes.
Ovarian Cyst Management During Pregnancy
If an ovarian cyst is discovered during pregnancy, it is often found incidentally during routine ultrasound scans. Most are functional and benign, frequently resolving on their own as the pregnancy progresses. The most common type seen in early pregnancy is the corpus luteum cyst, which produces hormones to support the developing pregnancy until the placenta takes over.
While most cysts cause no issues, potential complications can arise, though they are rare. These include the cyst growing very large, rupturing, or causing ovarian torsion, where the ovary twists on its blood supply. A ruptured cyst can cause sudden, severe pain, sometimes accompanied by nausea or vomiting. Ovarian torsion is an emergency requiring immediate medical attention due to the risk of damage to the ovary.
Cysts can also, in rare instances, obstruct the birth canal if they are very large and located in a way that blocks delivery. Healthcare providers typically monitor ovarian cysts during pregnancy with regular ultrasounds to track their size and characteristics. If complications occur, such as persistent pain, significant growth, or suspicion of malignancy, intervention may be considered.
Treatment Options for Ovarian Cysts
The approach to treating ovarian cysts depends on the cyst’s type, size, symptoms, and whether a woman is trying to conceive or is already pregnant. For many cysts, particularly functional ones, watchful waiting is the initial strategy, involving monitoring with follow-up ultrasounds to see if they resolve.
Medication, such as hormonal birth control, may be prescribed to prevent the formation of new cysts by suppressing ovulation, though this is not relevant for women actively trying to conceive. Pain relievers, including over-the-counter options, can help manage discomfort caused by cysts.
Surgical removal of an ovarian cyst, known as a cystectomy, may be recommended if the cyst is large, causing persistent symptoms, growing, or if there is concern about its nature. This can often be performed using minimally invasive laparoscopic surgery, which involves small incisions and a quicker recovery. In some cases, particularly for very large or complex cysts, open surgery (laparotomy) may be necessary.
For women planning to conceive, fertility-sparing surgeries aim to remove the cyst while preserving ovarian tissue to maintain reproductive function. If an ovarian cyst requires removal during pregnancy, it is often performed safely in the second trimester, typically via laparoscopy, especially if it is symptomatic, growing, or causing complications. In rare instances where both ovaries must be removed, future natural conception would not be possible.