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If you ask “the interwebs” if ovarian cysts cause infertility, you’ll be led down a windy, confusing road of Yes…No…Maybe? Truthfully, it is impossible to answer this question with a simple yes or no because the definition of “cyst” is so broad. A cyst is a fluid-filled sack. Some are completely benign and don't cause any negative symptoms, while others can be problematic due to their size, impact on hormones, or even malignancy.
To help us understand the different types of cysts and how they can affect fertility, we spoke to Levica H. Narine, MD, FACOG, a fertility specialist at The Kofinas Fertility Group in New York.
The different types of ovarian cysts
Some ovarian cysts are considered normal or “functional,” while others are considered "abnormal." Functional cysts occur as a normal part of the ovulation process. Each time an egg is released during ovulation, a small, fluid-filled sack, also known as a "follicle," forms around it. Occasionally, if no egg is released or, for some reason, the sack doesn’t rupture, it can fill up with fluid and cause some pain. But, for the most part, these cysts that form as a routine part of the menstrual cycle are not problematic and don’t contribute to fertility challenges. In fact, when it comes to IVF, the more follicles, the better!
Abnormal ovarian cysts and fertility
Abnormal ovarian cysts, on the other hand, can lead to significant challenges with fertility. Some are benign, while others may be malignant. Both can impact fertility in several different ways: They can alter hormones, negatively impacting the menstrual cycle; they can contribute to inflammation in the pelvic organs, decreasing overall function; or, their size and placement can impact reproductive organ function and processes. There are a few types of ovarian cysts that are considered "abnormal."
Endometriomas
Endometriomas, also known as ovarian endometriotic cysts or chocolate cysts, are cysts filled with old blood that form when tissue similar, but not identical, to the lining of the uterus (endometriosis) grows inside of the ovaries. These cysts can affect fertility in various ways:
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Disruption of ovarian function: Endometriomas can interfere with the normal function of the ovaries, including disrupting follicle development and ovulation. This can affect the release of eggs and therefore decrease fertility.
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Damage to ovarian tissue: The presence of endometriomas can lead to damage of ovarian tissue, affecting the quality and quantity of eggs produced by the affected ovary.
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Adhesion formation: Endometriomas can cause adhesions or scar tissue to form in the pelvic cavity, which may affect the mobility and function of the ovaries, fallopian tubes, and uterus. Adhesions can lead to fertility issues by obstructing the fallopian tubes or disrupting the normal anatomy of the reproductive organs.
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Inflammation: Endometriomas can cause inflammation in the surrounding ovarian tissue, which can further impair ovarian function and reduce fertility.
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Pain and discomfort: Endometriomas are often associated with pelvic pain, especially during menstruation or intercourse. Chronic pain can lead to stress and anxiety, which may negatively impact fertility.
Treatment for endometriomas aimed at improving fertility may involve surgical removal of the cysts, particularly in cases where the cysts are large or causing significant symptoms. However, it's essential to discuss treatment options with a healthcare provider who can consider your specific circumstances and fertility goals.
Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common hormonal disorder characterized by enlarged ovaries containing multiple small follicles (cysts). Here are a few ways in which PCOS can impact fertility:
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Irregular ovulation or anovulation: One of the hallmark features of PCOS is irregular ovulation or anovulation (lack of ovulation). Without regular ovulation, eggs may not be released from the ovaries, making it difficult to conceive.
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Hormonal imbalance: PCOS is associated with hormonal imbalances, particularly elevated levels of androgens (male hormones) such as testosterone. These hormonal imbalances can disrupt the normal menstrual cycle and inhibit ovulation.
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Insulin resistance: Many women with PCOS also have insulin resistance, which can lead to high levels of insulin in the blood. Insulin resistance can affect ovarian function and disrupt hormone levels, further contributing to irregular ovulation and infertility.
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Poor egg quality: PCOS may be associated with reduced quality of eggs, which can decrease the chances of successful fertilization and implantation.
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Endometrial changes: Women with PCOS may have alterations in the endometrial lining of the uterus, which can affect implantation and increase the risk of miscarriage.
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Increased risk of other health conditions: PCOS is often associated with other health conditions such as obesity, type 2 diabetes, and cardiovascular disease, which can also impact fertility and pregnancy outcomes.
Despite the challenges posed by PCOS, the good news is that many women with the condition are able to conceive with (or without) medical intervention. If you have PCOS and are trying to get pregnant, it's important to work closely with your healthcare provider to develop a personalized treatment plan tailored to your individual needs and goals.
Teratomas, or dermoid cysts
Teratomas, or dermoid cysts, are present from birth. While benign, these cysts can affect fertility depending on their size and placement.
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Malignant, or cancerous cysts
In extreme cases, an ovarian cyst may turn out to be malignant and will need to be removed surgically. Often, one or both ovaries will need to be removed as well, which can irreversably impact a person's future fertility. If your healthcare provider is recommending a oophorectomy, or complete removal of one or both of your ovaries, be sure to inquire about undergoing fertility preservation prior to your surgery.
Treatment options for ovarian cysts
When treating ovarian cysts, there are two approaches you might take. If the actual cyst is problematic, either because it's cancerous, or because it's causing physical discomfort, you may need to have it addressed surgically. Malignant cysts will be removed, while others may be able to be drained. In some cases, you might simply choose to treat the symptoms that the cyst is causing. For example, if PCOS is causing irregular periods, treatment will typically include medication or lifestyle changes to help regulate your cycle in hopes of improving fertility.
Remember, ovarian cysts are common, and, in the vast majority of cases, benign, but it's still important to listen to your gut. If you are experiencing any of these symptoms on a persistent basis — pelvic pain, bloating or swelling, pressure on the bladder or rectum, changes in the menstrual cycle, pain during intercourse, and/or nausea or vomiting — it's crucial to see a healthcare provider for evaluation and diagnosis. If you think ovarian cysts might be playing a role in your challenges with fertility, speak with your doctor so you can seek out the right treatment if needed. You've got this!
Johanna Modak is a writer specializing in women's health, nutrition, femtech, and women's sports.