Will ovarian cysts affect my fertility?

Ovarian cysts may sound scary, but they are actually very common in women who are ovulating. In fact, most women have at least one ovarian cyst in a month. Majority of these cysts are harmless, but some of them may affect your fertility. Let us help you to get a better understanding of ovarian cysts and their effects on your fertility.

What are ovarian cysts?
Ovarian cysts are sacs or cavities filled with fluid that form in the ovaries. Ovarian cysts are very common and many women will develop them in their lifetime. Most ovarian cysts do not cause discomfort and are harmless, and can even disappear without treatment. This is why ovarian cysts often go undetected. However, they can be found through ultrasounds or routine pelvic examinations.

Which ovarian cysts will affect my fertility, and how?
Not all ovarian cysts will affect your fertility. In fact, it is not the cysts themselves that make it harder to conceive, but rather it is the underlying illness causing these cysts that make pregnancy difficult. Polycystic ovary syndrome (PCOS) and endometriosis are some illnesses which cause ovarian cysts and can affect your fertility.

Polycystic ovary syndrome (PCOS)
PCOS is a chronic condition in which the ovaries produce too much male sex hormones (androgens). It causes many small ovarian cysts and affects about 20% of women. However, some people with this condition do not develop cysts.

In PCOS, because of the hormonal imbalance, the eggs that develop during ovulation do not mature enough to trigger ovulation, so they are never released from the ovary. The immature follicles that each contain an immature egg cause the ovary to become “polycystic” – filled with tiny cysts.

Common symptoms of PCOS include:

Weight gain
Acne
Mood swings
Irregular, light, or no periods
Excessive hair growth
Difficulty conceiving
Ovaries that are large or have many cysts
Male-pattern baldness or thinning hair
Dark or thick skin patches on the back of the neck, in the armpits and under the breasts
Women with PCOS can still get pregnant naturally, but some need medication to help to regulate ovulation or begin ovulation. Clomiphene is often used to help these women stimulate ovulation to release the egg from their ovaries.

If medication does not work, you may opt to go for a minor surgery, known as laparoscopic ovarian drilling (LOD) in order to destroy the abnormal tissues that produce the male hormones causing PCOS. The outcome would be to restore hormonal balance and normal functioning of the ovaries such that you can increase the chances of pregnancy again.

Picture of a lady experiencing stomach pain
Endometriosis
Endometriosis is when the endometrial tissue, or the lining of the uterus, grows in other places outside the uterus such as in the fallopian tubes. This can result in ovarian cysts known as endometriomas, formed when the tissue grows in the ovaries. The size of endometriomas can range from smaller than an inch to over 6 inches.

Symptoms of endometriosis include:

Pelvic pain
Extreme period pain
Heavy periods
Pain during or after sex
Pain when urinating or defecating during your period
Constipation or diarrhoea
Blood in your pee during your period
Difficulty conceiving
Endometriosis is closely related to infertility. Some studies show that women with mild cases of endometriosis only have a 2-4% chance of conceiving as compared to a 15-20% chance in healthy women. Doctors still aren’t sure how endometriosis affects fertility, but suspect that it has something to do with decreasing the ovarian reserve, anatomical distortion and inflammation.

Can ovarian cysts cause other problems?
Ovarian cysts are usually “functional”, meaning they occur due to the normal ovulation process and will disappear by themselves. However, there may be complications such as the rupturing of the cysts, causing bleeding and abdominal pain.

Sometimes, “pathological cysts” may form. There are several types, such as dermoid cysts which contain teeth, skin or hair tissues, or cystadenomas filled with liquid or mucus. Both types of cysts may require removal via surgery. However, the surgery likely does not affect fertility, except if the entire ovary is removed, which only happens in extremely rare cases where the cysts are large, complicated, or cancerous. Cancerous (malignant) cysts are very rare in young women.

For larger ovarian cysts, there is a concern for twisting of the ovary, known as ovarian torsion. Ovarian torsion can lead to the loss of an ovary if not corrected in time through surgery.

Can treatment for ovarian cysts affect my fertility?
Whether treatment for ovarian cysts will affect fertility depends on the type of treatment itself. For benign cysts, there can be treatments such as hormonal birth control which prevent ovulation and lower the chances of getting more cysts. Hormonal birth control does not affect long-term fertility.

Surgery may damage some healthy eggs. Complications in surgery, in rare cases, may require removal of the entire ovary, which can affect your fertility. Surgical treatment of endometriosis offers a long-term pain relief solution, but it may reduce ovarian reserve and hence fertility.

Should I freeze my eggs if I have ovarian cysts?
Although ovarian cysts may not all lead to infertility, there are some cases where women would want to consider freezing their eggs.

Women with endometriosis who are not planning to get pregnant yet could consider egg freezing. The abnormal endometrial tissue can cause scarring, inflammation, cysts, and organ damage such as damage to the ovary. If the ovary is damaged, it can mean that ovulation or egg production may be affected.

Surgery also has risks of reducing fertility. Freezing eggs before your endometriosis progresses further or prior to surgery is a good way to ensure your chances of having a baby are preserved.

Conclusion
Don’t be afraid of ovarian cysts – they are more common than you think and more often than not, they do not cause major problems to you or your fertility. If you have symptoms of PCOS or endometriosis, consult your doctor and they will advise you on the next step forward.

References
How do ovarian cysts affect fertility? (n.d.). Retrieved August 6, 2021, from https://extendfertility.com/how-do-ovarian-cysts-affect-fertility/
Do Ovarian Cysts Affect My Chances of Becoming Pregnant? | Ovarian Cysts & Fertility. (n.d.). Retrieved August 6, 2021, from https://www.londonwomenscentre.co.uk/info/news/ovarian-cysts-affect-chances-becoming-pregnant
Di Guardo, F., Shah, M., Cerana, M. C., Biondi, A., Karaman, E., Török, P., Yela, D. A., Giampaolino, P., Marín-Buck, A., & Laganà, A. S. (2019). Management of women affected by endometriosis: Are we stepping forward? In Journal of Endometriosis and Pelvic Pain Disorders (Vol. 11, Issue 2, pp. 77–84). SAGE Publications Sage UK: London, England. https://doi.org/10.1177/2284026519841520
This article was written and medically reviewed by Dr Tan Poh Kok (PK Tan), a Senior Consultant Obstetrician and Gynaecologist at PK Women’s Specialist Clinic.