Ovarian cysts are fluid-filled sacs within or on an ovary. While their presence can be concerning, having one does not automatically prevent conception. The ability to conceive depends on the cyst’s type, size, and any associated underlying conditions.
Identifying Impactful Types of Ovarian Cysts
Many ovarian cysts are functional, developing as a normal part of the menstrual cycle and typically not affecting fertility. Follicular cysts form when a follicle fails to rupture and release an egg. Corpus luteum cysts occur after an egg is released, when the sac reseals and fills with fluid or blood. These functional cysts often resolve on their own within a few menstrual cycles and usually do not interfere with conception.
Certain pathological cysts can impact fertility. Endometriomas, or “chocolate cysts,” are linked to endometriosis, a condition where uterine-like tissue grows outside the uterus. These cysts form when endometrial tissue attaches to the ovary, causing inflammation and scarring. Endometriomas indicate endometriosis, which impairs fertility.
Dermoid cysts, or mature cystic teratomas, are non-cancerous growths from embryonic cells, containing various tissues like hair or skin. While dermoid cysts do not typically affect fertility, large ones pose a risk of ovarian torsion, a medical emergency where the ovary twists around its blood supply. Torsion can damage the ovary and reduce its function if not promptly treated.
Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by multiple small “cysts” on the ovaries. These are underdeveloped follicles that fail to release eggs regularly. The main fertility concern with PCOS is the underlying hormonal imbalance, which leads to irregular or absent ovulation.
How Ovarian Cysts Can Affect Fertility
Ovarian cysts can interfere with conception through several mechanisms, often linked to the cyst type or underlying condition. Hormonal imbalances are a concern, especially in conditions like polycystic ovary syndrome (PCOS). PCOS involves elevated androgens and often insulin resistance, disrupting hormonal signals necessary for regular ovulation. This disruption can prevent the ovaries from releasing an egg consistently, making conception difficult.
Physical obstruction or distortion of reproductive anatomy can impair fertility. Large cysts, such as dermoid cysts or endometriomas, can block or distort the fallopian tubes, preventing egg travel from the ovary to the uterus. They can also alter the ovary’s position and function, interfering with egg release or capture by the fallopian tube. Such structural changes hinder fertilization.
Chronic inflammation and scarring, particularly associated with endometriomas and the underlying condition of endometriosis, impact fertility. Endometrial tissue within the endometrioma causes ongoing inflammation, leading to the formation of scar tissue (adhesions) around the ovaries, fallopian tubes, and other pelvic organs. These adhesions can bind reproductive organs, preventing proper function and affecting egg quality or embryo implantation. The inflammatory environment can also be detrimental to egg and sperm viability.
Certain cysts or their surgical removal can affect the ovarian reserve, which is the number of healthy eggs remaining. While surgeons aim to preserve as much healthy ovarian tissue as possible during cystectomy, especially for large cysts like endometriomas, some tissue loss can occur. This reduction in ovarian reserve can impact future fertility, particularly if both ovaries are affected or if a woman is older and already has a diminished reserve.
Navigating Conception and Pregnancy
For individuals with ovarian cysts trying to conceive, a medical consultation is an important initial step. A healthcare provider can conduct an evaluation, often involving a pelvic exam and ultrasound, to determine the cyst’s type, size, and characteristics. Further tests, such as blood work, may identify underlying conditions like PCOS or endometriosis, which are factors in fertility.
Treatment options vary based on the cyst type and its impact on fertility. For small, asymptomatic functional cysts, “watchful waiting” is often recommended, as they frequently resolve without intervention. If PCOS is identified, medical management may involve lifestyle adjustments like diet and exercise, and medications to regulate hormonal imbalances or induce ovulation. Ovulation-inducing medications, like clomiphene citrate or letrozole, can stimulate egg release in women with irregular cycles.
Surgical intervention becomes an option when cysts are large, cause significant symptoms, or are clearly impairing fertility. Procedures like ovarian cystectomy aim to remove the cyst while preserving as much healthy ovarian tissue as possible. This approach is important for conditions like endometriomas, where removing the cyst can alleviate symptoms and improve conception chances, though underlying endometriosis may still require ongoing management. Minimally invasive laparoscopic techniques are often preferred to reduce recovery time and potential impact on ovarian function.
When natural conception remains challenging despite management of cysts or underlying conditions, fertility treatments may be considered. Intrauterine insemination (IUI) involves placing sperm directly into the uterus around the time of ovulation, increasing the chances of fertilization. In vitro fertilization (IVF) is another option, where eggs are retrieved from the ovaries, fertilized in a laboratory, and then the resulting embryos are transferred into the uterus. IVF can be particularly beneficial for those with tubal damage from cysts or endometriosis, or severe ovulation issues.
Should a cyst be discovered or persist during pregnancy, it is typically monitored closely by healthcare providers. Most ovarian cysts found during pregnancy are benign and do not cause complications, often resolving on their own. However, larger cysts or those causing symptoms may require careful observation or, in rare cases, surgical removal during the second trimester to prevent complications like torsion or rupture. Many women with ovarian cysts successfully conceive and experience healthy pregnancies, highlighting that the presence of a cyst does not necessarily preclude motherhood.