CAN OVARIAN CYSTS CONTRIBUTE TO INFERTILITY?

One of the most common questions fertility doctors receive is whether or not ovarian cysts adversely affect fertility. The answer is: It depends on the type of cyst. The types of ovarian cysts that impact fertility include:

• Endometriomas – these types of cysts are caused by endometriosis. Endometriosis is a condition that causes tissue normally found lining the uterus to grow in other areas including on the ovaries, fallopian tubes, bowel  or bladder.  

  The endometriosis usually starts off small but with time,  large cysts can form. These large cysts can damage the ovaries, cause adhesions and block the fallopian tubes leading to infertility problems.

• Polycystic ovary syndrome – PolyCystic Ovary Syndrome (PCOS) is a condition that leads to hormonal imbalances and infertility. Although the name is called Polycystic ovary syndrome, there are no true ovarian cysts involved.   Unfortunately most women think they have ovarian cysts when they have PCOS because of the name of this disease, but they really do not.

  Polycystic Ovary Syndrome has three diagnostic criteria and woman must have 2 of the 3 to have PCOS.  The 3 criteria are irregular menses since puberty (when not on Birth control pills), androgen excess (acne, excessive hair growth, or an elevated testosterone blood level) and PCOS appearing ovaries by ultrasound.

Functional cysts – these are the most widespread type of ovarian cyst. Functional cysts appear as a woman menstruates, and actually indicate the right processes are occurring for conception to take place.

• Cystadenomas – cystadenomas are benign cysts that can grow on the ovary. They should not be ignored, and need medical treatment, but are not known to cause fertility problems directly. 

  Indirectly if the cystadenoma is not treated early enough a woman with a cystadenoma can lose her ovary (therefore decreasing fertility), have a large portion of their ovary removed due to the cyst (decreasing egg supply)  or have adhesions from the surgery to remove the cyst.

  Women who lose an ovary often think that their fertility is decreased by 50%, however when a woman loses an ovary her fertility declines only by 15-25% on average.

• Dermoid cysts – dermoid cysts are formed at birth and enlarge as one gets older.  These cysts can contain various tissue including teeth, skin, and hair instead of the normal fluid found within cysts. Although these cysts typically do not affect fertility directly, women who have had dermoid cysts can have a decline in fertility if they have lost an ovary from the dermoid or  have a decrease in ovarian function from the surgery to remove the dermoid.

Not all ovarian cysts cause fertility problems, These cysts do not cause infertility, but in fact can demonstrate good fertility:

• Functional cysts – these are the most common type of ovarian cyst. Two cysts occur during a normal menstrual cycle in all women who are ovulating.

  The first cyst is a follicle cyst.  This cyst contains the maturing egg that will be released at the time of ovulation. The second cyst is the corpus luteum cyst.  This cyst is formed from the follicle cyst after the egg is released and is responsible for making the hormone progesterone.

It should be noted that any of these cysts could have an impact on fertility depending on their size. Normal sized cysts of this nature do not commonly impact fertility, but cysts that are large enough may cause issues.

Ovarian cysts are commonly diagnosed via ultrasound. Pelvic examinations can fail to detect small cysts about 50% of the time. Contrary to popular belief, the vast majority of ovarian cysts do not impact pregnancy or overall health. Having a cyst may not be cause for alarm, but should be checked by a doctor.

It is important to mention that a woman who is ovulating normally will develop a cyst each month known as a follicle – this is entirely normal.

It is important to see your Gynecologist in Denver if you discover a cyst of any kind.

Individuals with ovarian cysts with fertility concerns (i.e. want kids in the future) should speak to a fertility clinic in Colorado regarding possible healthcare concerns affecting fertility because of the ovarian cyst.  Your Colorado fertility doctor can work with you to seek proper options to preserve your fertility as best as they can.