Do Ovarian Cysts Affect Fertility?

Ovarian cysts are fluid-filled sacs that can be found on or inside the ovaries. They are very common, with many women developing them at some point in their lives. Most are harmless and cause no symptoms or pain, which is why they usually go undetected, disappearing over time without the need for medical intervention.

The common question that comes to mind with ovarian cysts is that they affect fertility. Do they have any link with a lower chance of becoming pregnant? The answer is that it totally depends on the type of cysts you have. While ovarian cysts can occur naturally with your menstrual cycle, they may also be a symptom of conditions like endometriosis and PCOS. Determining the cause of ovarian cysts can help you know whether they may affect your fertility.

Understanding Ovarian Cysts

As we all know that all ovarian cysts are not the same. They are mainly categorized into two major types such as functional cysts and pathological cysts.

Functional cysts: these are the common type of cysts that include corpus luteum cysts and follicular cysts. These are mainly related to your normal menstrual cycle. Follicular cysts form when the egg is not released properly, while luteum cysts develop when the egg is released.

Functional cysts typically resolve on their own within a few weeks or months and do not usually interfere with fertility.

Pathological cysts: these are the cysts that occur due to medical conditions such as endometriosis, dermoid cysts, cystadenomas, and cysts seen in Polycystic Ovary Syndrome (PCOS). These cysts often affect the function of the ovaries and their fertility.

Types of Ovarian Cysts Affecting Fertility

The relationship between fertility and ovarian cysts hinges on the nature of the cysts. Some of the cysts have no or little effect on their fertility, while some cysts significantly affect women’s reproductive health.

Endometriomas (Ovarian Endometriosis Cysts): These are cysts that are formed when endometrial tissues grow on the ovaries and also line the uterus. This is a part of a broader condition called endometriosis, which causes scarring and inflammation. Women who are diagnosed with endometriosis have harder time getting pregnant as compared to others. It damages the ovarian tissue and leads to inflammation, impairs egg quality, ovarian function, and fertility.
Polycystic Ovary Syndrome (PCOS): When we talk about PCOS, it is characterized by various small cysts associated with the ovaries and is considered to be a leading cause of infertility. These cysts generally take place due to hormonal imbalances that disrupt the normal ovulation while causing irregular periods or absent menstrual cycles, making it difficult to conceive. Women diagnosed with PCOS have elevated levels of androgen, insulin resistance, and other metabolic symptoms.

While PCOS is associated with cysts on the ovaries, the cysts themselves are more a symptom of the syndrome rather than the direct cause of infertility.

Dermoid Cysts and Cystadenomas: Dermoid cysts are benight growth that contain different type of tissues such as skin, hair or teeth.
Dermoid cysts are benign growths containing different tissue types like hair, skin, or teeth. These cysts can grow large and sometimes require surgical removal. Surgery can sometimes reduce ovarian reserve if a significant part of the ovary is removed. Cystadenomas are fluid-filled cysts that can also grow large and distort the ovary. If untreated, both dermoid cysts and cystadenomas can impair ovarian function or lead to complications such as ovarian torsion (twisting), which may impact fertility.

Do Ovarian Cysts Reduce Fertility?

Most ovarian cysts, especially functional cysts, do not reduce fertility. These cysts are part of the natural ovulation process and usually resolve without intervention or impact on reproductive potential. However, cysts that are large, persistent, or related to conditions like endometriosis or PCOS can affect fertility by:

Disrupting ovulation: Cysts can cause hormonal imbalances that interfere with the release of eggs, preventing ovulation.
Damaging ovarian tissue: Conditions like endometriomas or repeated cyst ruptures can damage ovarian tissue, reducing the pool of viable eggs.
Causing adhesions or blockage: Surgical removal of cysts or the cysts themselves can cause scar tissue or adhesions, potentially blocking the fallopian tubes or disrupting the anatomy necessary for fertilization.
Pain and discomfort: Large cysts may cause pelvic pain, which can affect sexual intercourse and thus conception chances.

It is important to note that losing one ovary due to cyst complications or surgery usually does not reduce fertility by half, as the remaining ovary often compensates by producing healthy eggs. Fertility typically declines by about 15-25% after the loss of one ovary.

Diagnosis and Monitoring

Ovarian cysts are typically diagnosed through pelvic ultrasound, which can determine the cyst’s size, type, and characteristics. Many cysts are asymptomatic and harmless, requiring only observation. Regular monitoring helps to keep track of any growth or changes that might warrant further intervention. Pelvic exams may miss smaller cysts about half the time, so imaging is important for accurate diagnosis.

Treatment and Fertility Preservation

Treatment depends on the type of cyst, its size, symptoms, and whether fertility preservation is a priority. Options include:

Watchful waiting: Most functional cysts disappear on their own and do not require treatment.
Hormonal therapy: Birth control pills or hormone medications may be prescribed to regulate the menstrual cycle and prevent new cyst formation, especially in PCOS.
Surgery: Large, persistent, or symptomatic cysts may require surgical removal. Minimally invasive fertility-sparing surgeries (like laparoscopic cystectomy) aim to remove cysts while preserving healthy ovarian tissue to maintain fertility.
Fertility treatments: If cysts have impacted fertility, assisted reproductive technologies such as ovulation induction or IVF may be recommended.

Advancements in surgical techniques have improved fertility outcomes post-operatively by minimizing damage to the ovary and preserving ovarian function.

Can You Get Pregnant with Ovarian Cysts?

Yes, many women with ovarian cysts conceive naturally without problems, especially if the cysts are functional and small. However, if cysts are caused by underlying conditions like endometriosis or PCOS, fertility may be reduced but still manageable with proper medical care and fertility treatments.

When to See a Doctor

Women should consult a healthcare provider if they experience:

Persistent pelvic pain or discomfort
Irregular menstrual cycles or missed periods
Difficulty conceiving after one year of trying (or six months if over age 35)
Symptoms of complications, like sudden, severe abdominal pain or bloating

Early diagnosis and management of ovarian cysts, especially those affecting fertility, can improve reproductive outcomes and overall health.