A dermoid cyst, also known as a mature cystic teratoma, is a common type of ovarian cyst. It forms from germ cells and can contain various mature tissues, such as skin, hair, and fat. These cysts are non-cancerous and, unlike functional cysts, do not typically resolve on their own. For individuals of reproductive age, the primary concern is whether the cyst or its treatment interferes with the ability to conceive. While dermoid cysts are not a direct cause of infertility, their location and the potential need for surgical intervention introduce specific risks to reproductive health.
Characteristics of Ovarian Dermoid Cysts
Dermoid cysts originate from totipotent germ cells, which can develop into many different cell types, explaining the unexpected tissues found within the cyst. Because these cysts develop directly on the ovary, their presence is relevant to fertility. The finite pool of eggs available for conception is known as the ovarian reserve, which is often assessed by measuring the Anti-Müllerian Hormone (AMH) level.
Although dermoid cysts are benign, their growth can place pressure on the surrounding ovarian tissue. Any mass near or within the ovary must be monitored, particularly if it grows larger than five centimeters, as size is a determining factor for management decisions. The cyst itself generally does not affect ovulation or hormone production.
Direct Impact on Ovarian Function
While small dermoid cysts may not immediately impede conception, larger cysts can interfere with ovarian function. A significant risk, especially for cysts exceeding five centimeters, is Ovarian Torsion. Torsion occurs when the cyst’s weight causes the ovary to twist around its supporting ligaments, cutting off the blood supply. Ovarian torsion is a medical emergency that can lead to the loss of the entire affected ovary if blood flow is not quickly restored. The risk of torsion increases during pregnancy, as the enlarging uterus can alter the ovary’s position. Furthermore, if the cyst contents (such as fatty material and hair) leak or rupture, they can cause significant inflammation and the formation of scar tissue, known as adhesions, within the pelvis. These adhesions can mechanically block the fallopian tube, preventing the egg and sperm from meeting, which directly impacts natural conception.
Fertility Outcomes After Surgical Intervention
Surgical removal is often required for dermoid cysts that are large, symptomatic, or pose a risk of torsion. The goal of surgery is typically an Ovarian Cystectomy, which involves removing only the cyst while preserving the maximum amount of healthy ovarian tissue. Maintaining the ovarian reserve is a concern during this procedure, as the delicate ovarian cortex, which contains the eggs, can be inadvertently damaged by heat, dissection, or bleeding control. The extent of damage to the ovarian reserve depends on the surgeon’s skill and the cyst’s size and location. Studies tracking AMH levels post-surgery show a measurable decrease, indicating a reduction in the remaining egg supply in the operated ovary. If the cyst has extensively damaged the ovary or in cases of emergency due to torsion, an Oophorectomy (removal of the ovary) may be necessary. Losing one ovary does not eliminate the possibility of natural conception, as the remaining ovary can often compensate, but it does reduce the overall reserve.
Monitoring and Planning for Conception
For individuals who have undergone cystectomy, post-operative monitoring is important for assessing future fertility potential. A key step is measuring AMH levels approximately three to six months after the procedure to evaluate the impact on ovarian reserve. This post-surgical AMH level provides a baseline for understanding the current egg supply and informs the timeline for trying to conceive. Fertility specialists often recommend waiting a few months after surgery to allow the ovary to heal fully before attempting conception. If the dermoid cyst was large or if the AMH level shows a significant decline, individuals may consider consulting a reproductive endocrinologist sooner than the typical one-year mark. Although surgery can affect ovarian reserve, research suggests that overall pregnancy rates and IVF success rates remain comparable to those without a history of dermoid cysts.