Ovarian cysts are fluid-filled sacs that develop on a woman’s ovaries. Many women develop them at some point, and while most are harmless, some types can impact fertility and make getting pregnant difficult. Understanding how different cysts affect fertility and what options exist for achieving pregnancy is crucial for women hoping to conceive. This complete guide covers everything you need to know about ovarian cysts and pregnancy.
An Overview of Ovarian Cysts
Ovarian cysts are extremely common, with most women developing them at some point in their lives. There are various types of cysts, but they can be broadly categorized as either functional or pathological cysts .
Functional cysts occur as part of the normal menstrual cycle. Each month, the ovaries grow follicles which contain eggs. These follicles eventually rupture to release the eggs for potential fertilization. The follicle then transforms into a corpus luteum cyst that produces progesterone to support early pregnancy. Corpus luteum cysts typically disappear by the second trimester. Other functional cysts like follicular cysts resolve within one to three menstrual cycles and don’t require treatment .
Pathological cysts result from abnormal cell growth. The most common types include:
- Endometriomas: Also called “chocolate cysts,” these form when uterine endometrial tissue grows abnormally on the ovaries. The old blood appears brown like chocolate. They are associated with endometriosis.
- Cystadenomas: These develop from ovarian tissue and can become quite large. They are usually benign.
- Dermoid cysts: These abnormal cysts contain tissue like hair, teeth, bone, and skin glands. They develop from embryonic cells.
- Polycystic ovaries: This refers to ovaries with numerous small cysts along the outer edges. It occurs due to a hormone imbalance in women with polycystic ovary syndrome (PCOS).
How Ovarian Cysts Affect Fertility
Most functional ovarian cysts are harmless and don’t impact your ability to get pregnant. Your body continues to ovulate normally and release eggs every month. However, certain pathological cysts can make getting pregnant difficult :
- Endometriomas are strongly associated with infertility, especially if both ovaries have cysts. However, it’s not the cysts themselves that directly cause infertility. The problem is that endometriosis can severely damage the ovaries and fallopian tubes over time. Scarring and adhesions interfere with ovulation, egg release, and embryo transport. Up to 50% of women with endometriosis struggle with infertility.
- PCOS prevents normal ovulation due to hormone imbalances. The many small cysts are a symptom of the condition. Without ovulation, pregnancy can’t occur. PCOS is one of the most common causes of infertility.
- Cystadenomas and dermoid cysts can grow very large. This mass effect may move ovaries out of position, blocking the fallopian tubes. However, fertility is usually restored if the cysts are removed.
- Ovarian torsion caused by large cysts can cut off blood flow to the ovaries. This damages the ovarian tissue and leads to loss of eggs and hormone production.
- Cyst removal surgery aims to preserve ovarian function, but can still reduce fertility from scar tissue formation or direct damage to eggs. The more ovarian tissue removed, the higher the risk of reduced ovarian reserve.
Getting Pregnant With Ovarian Cysts
Despite the risks, many women with ovarian cysts do successfully become pregnant either spontaneously or with treatment. Here are some key points:
- Most functional cysts won’t interfere with spontaneous pregnancy. You can likely conceive naturally without treatment. Exceptions include very large or persistent cysts.
- Pathological cysts like endometriomas have higher risks. Your doctor will evaluate options like cyst removal before pregnancy vs leaving them alone. Expectant management may be recommended first.
- PCOS makes spontaneous pregnancy unlikely. Treatment involves medications to induce ovulation, followed by intrauterine insemination or IVF if needed after 6 months of trying. Losing excess weight also helps.
- Women over 30 have higher risks of age-related infertility on top of cyst issues. Seeing a fertility specialist right away improves your chances.
- Ovarian reserve testing assesses egg supply. AMH, antral follicle count (AFC) and FSH are common markers. Low values indicate diminished reserve.
- High AMH could signify PCOS. Very low AMH means reduced egg quantity, requiring urgent treatment.
- If cyst removal is necessary, minimally invasive laparoscopic surgery can often preserve fertility. Avoiding damage to healthy ovarian tissue is key.
- Pre-IVF cyst aspiration can obtain eggs from the cysts themselves to use during IVF treatment. This avoids waste of eggs.
- IVF with ICSI may be needed when cysts interfere with natural ovulation and fertilization. Success rates vary based on age and diagnosis.
Getting Pregnant After Ovarian Cyst Removal Surgery
Many women undergo ovarian cyst removal at some point. The risks of reduced fertility after surgery depend on several factors:
- Removing only the cyst while preserving the ovary has minimal long-term impact on fertility for most women .
- Losing the entire ovary has higher risks, especially if fertility was already declining with age. AMH levels decrease by about 50% after losing an ovary.
- Very extensive removal of ovarian tissue increases risks further. Removal of both ovaries requires egg donation to achieve pregnancy.
- The remaining ovary may compensate to some degree for loss of the other ovary by producing more eggs each cycle. Age impacts this ability to compensate.
- After cyst removal, the best steps are close monitoring and prompt treatment if pregnancy doesn’t occur after 6 months of trying. Seeking specialist care right away is recommended.
- Ovarian reserve testing can identify reduced egg supply after surgery so treatment like IVF can start immediately before further decline.
- IVF with ICSI may be needed to achieve pregnancy after losing ovarian tissue. Younger women have higher success rates.
- Egg or embryo freezing before cyst surgery is an option to preserve fertility for the future. The frozen eggs or embryos can later be used for IVF.
Getting Pregnant With Ovarian Cysts Using IVF
In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has high success rates for women with ovarian cysts struggling to get pregnant naturally. Here’s how it works:
- IVF stimulates the ovaries to produce multiple mature eggs in one cycle. This helps overcome low egg supply from cysts.
- The eggs are retrieved from the ovaries using a needle guided by ultrasound. Cysts do not prevent egg retrieval.
- If cysts could make retrieval risky, they may be drained before the IVF cycle through a simple aspiration procedure.
- ICSI involves direct injection of a single sperm into each mature egg to achieve fertilization. This bypasses any fallopian tube damage from cysts.
- Once fertilized, the embryos grow for 3-5 days before transfer into the uterus for implantation. Extra quality embryos can also be frozen.
- Single embryo transfer is often done to avoid high-risk multiple pregnancies. Additional frozen embryos provide extra chances for conception.
- Success rates vary based on the woman’s age and diagnosis. Younger women with isolated cyst issues have higher success compared to older women with diminished ovarian reserve.
- IVF pregnancy rates are around 41-43% per cycle for women under 35, 27-33% for those 35-37, 19-27% for ages 38-40, and 6-15% for women over 40 .
Can Ovarian Cysts Affect Early Pregnancy?
Ovarian cysts found in early pregnancy generally don’t cause complications and often resolve on their own. However, some key points:
- Corpus luteum cysts that produce progesterone are vital for supporting early pregnancy until the placenta takes over. These “pregnancy cysts” usually disappear by 10-12 weeks gestation.
- Most cysts found in early pregnancy are benign functional cysts or benign tumors. The risk of ovarian cancer is very low.
- Persistent complex cysts over 5-6 cm may require monitoring for potential complications like rupture, bleeding or ovarian torsion.
- Cysts are initially monitored rather than removed given the surgical risks in pregnancy. However, surgery may become necessary for large, symptomatic or suspicious cysts.
- Cyst rupture usually causes pain but doesn’t harm the pregnancy. Bleeding only occasionally affects the fetus.
- Ovarian torsion requires prompt surgery. Untreated torsion can damage the ovaries and threaten the pregnancy.
- Ultrasound and MRI help distinguish benign vs worrisome cysts and guide treatment in pregnant women.
Optimizing Your Chances of Getting Pregnant With Ovarian Cysts
Here are some final tips for optimizing your fertility when trying to conceive with ovarian cysts:
- Follow your doctor’s advice closely regarding diagnosis, proper management and timing of treatment.
- Seek prompt specialist care if pregnant doesn’t occur within 6 months. Don’t delay workup and treatment.
- Ask about medications to stimulate ovulation if needed to improve egg release. Letrozole and clomiphene citrate are options.
- Losing excess weight through diet and exercise helps balance hormones in women with PCOS. Even 5-10% weight loss makes a difference.
- Quit smoking, as it can accelerate ovarian aging and decline in egg quality. Limit alcohol intake.
- Consider acupuncture, stress reduction techniques, antioxidants and other holistic approaches to support ovarian and reproductive function.
- Stay positive, patient and hopeful when dealing with cysts. Stress and anxiety can affect fertility treatment outcomes. Having social support helps.
- Evaluate your lifestyle and make sure you are doing everything possible to optimize not just ovarian health, but your overall wellbeing.
The Bottom Line
Most women with ovarian cysts do eventually get pregnant, either spontaneously or with medical assistance. Specific risks depend greatly on the type of cyst and underlying ovarian health. Working closely with your doctor for proper diagnosis, management and treatment is crucial. Have a thorough evaluation to identify risks early, and promptly seek specialist care if conception difficulties arise. Remain hopeful – with today’s many options, most ovarian cyst issues can be successfully overcome.