“Could Ovarian Cysts Stop Me from Having a Baby?”
The term “ovarian cyst” is sometimes confusing and misleading. So, let us review some basic facts. “Cyst” is the generic name for a fluid-filled sac or cavity that can form in many places of the human body. A cyst is not a normal part of the tissue where it is located. It has a distinct membrane and is separated from nearby tissue by an outer (capsular) portion that is called the cyst wall. They vary in size from small (mm) to large (cm). The majority of ovarian cysts are benign and can be diagnosed by transvaginal ultrasonography. Up to 18 percent of women will be diagnosed with an ovarian cyst at some time in their life, and only a small percentage of them will be diagnosed with ovarian cancer.
Ovarian cysts may or not affect fertility. There are relatively common functional cysts that sometimes form as a byproduct of the process of ovulation. In a regularly ovulatory woman, each month, an egg grows in an ovarian follicle, the ovarian follicle grows from around 5-7 mm (antral follicle) to 20 mm (Graafian or preovulatory follicle), the egg inside that follicle matures, and then ovulatory signals (LH surge) trigger the release of the mature egg out of the follicle before traveling down the fallopian tubes.
Two types of functional cysts are common byproducts of ovulation:
- Follicular cysts form when, instead of rupturing to release the egg, the follicle stays intact, and the cyst continues to grow by fluid accumulation. They can happen at any age, teen-age to perimenopause.
- Corpus luteum cysts, or luteal cysts, sometimes form after ovulation. Normally, once the egg has been released, the follicle converts into a mass of cells known as the corpus luteum, which produces hormones (progesterone) to prepare the endometrial lining making it receptive for implantation. Luteal cysts form when, instead of shrinking, the follicle reseals itself and fluid (and blood) builds up inside.
Both types of cysts are harmless and typically disappear within 1–3 months without treatment. You just watch them by ultrasound in the next cycles and typically go away. Sometimes follicular cysts can secrete estrogen but will respond with oral contraceptive pills for a month and regress. Importantly, unless complicated by a large size and pain or torsion of the ovary, these cysts should not be subjected to surgical intervention. Any unnecessary surgery may lead to removal of normal tissue and affect future ovarian reserve.
On the other hand, there are other ovarian cysts, some of which may affect your fertility and include:
- Endometriomas, are ovarian cysts caused by endometriosis, a condition in which the tissue normally lining your uterus (endometrium) grows outside the uterus. These ovarian cysts may be associated with fertility problems.
- Ovarian cysts resulting from polycystic ovary syndrome (PCOS) which is a hormonal-metabolic condition marked by irregular periods, high levels of certain hormones. associated with irregular or no ovulation, and a multi-follicular ultrasonographic ovarian appearance. These multiple small follicles with immature eggs are not cysts, although sometimes are erroneously referred to as “cysts”. But occasionally, some of these follicles may become truly cystic. The underlying endocrine anomalies may lead to infertility in some cases, not the follicles.
- Cystadenomas, which are growths (tumors) in the ovary that arise from the surface of the ovaries. Although they need treatment, they do not affect fertility.
- Dermoid cysts.These are more solid cysts (tumors) contain tissue -such as skin, hair or even teeth- instead of fluid. They also require treatment but are not associated with infertility.
Should women with ovarian cysts freeze their eggs? Women with endometriomas, or recurrent endometriosis or other true cysts, that are not yet ready to get pregnant are excellent candidates for egg freezing.
If you’ve been diagnosed with an ovarian cyst and you are concerned about becoming pregnant, talk to your doctor. Keep in mind that in most instances, it is not these cysts themselves that make it harder to get pregnant, rather they are simply symptoms of larger illnesses that may compromise fertility.
At the Sher Fertility Institute, New York, we will help you achieve your goal of starting a family. For further information please Request An Appointment or call us at (646) 792-7476.