Can ovarian cysts affect your ability to get pregnant?

There are two types of ovarian cysts. Here's everything you need to know about them from the signs, treatment and whether you should worry if they will cause infertility.

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Ovarian cysts are simply fluid-filled sacs on, or within, the ovaries. Though they might not come up in conversation, they’re actually very common—many, if not most, women will experience a cyst at some point during their lives. But not all ovarian cysts are the same—while some are harmless, others can affect your ability to get pregnant. Here’s what you need to know.

Functional cysts
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“Functional cysts are the most common type and they form during a normal menstrual cycle,” says Danielle Derrington, head of service family medicine obstetrics at St. Joseph’s Healthcare in Hamilton, Ont. Every month, your body grows a cyst-like structure, called a follicle, in which an egg develops. When the egg is released, the follicle should break down on its own, but sometimes it keeps growing and filling with fluid, forming a functional cyst. These cysts are typically harmless, rarely cause symptoms and should resolve on their own within a few menstrual cycles. However, they can contribute to infertility if they grow very large.

Symptomatic cysts
There are three other types of cysts that are unrelated to the menstrual cycle, and are more likely to cause pain or other uncomfortable symptoms. Dermoid cysts can contain human bone fragments, tissue, hair and even teeth (this happens because they develop from the cells that create ova). They sound scary, but they are usually benign. Cystadenomas, meanwhile, are fluid- or mucus-filled sacs that develop out of ovarian tissue. In some cases, these can be cancerous, but they’re usually not. Both dermoid cysts and cystadenomas can grow large, sometimes shifting the position of the ovary and causing it to twist—a painful condition known as ovarian torsion. Finally, an endometrioma is a cyst related to endometriosis. These cysts are sometimes called “chocolate cysts” because of their dark colour. They grow out of endometrial tissue on the outside of the uterus, and can attach themselves to surrounding areas and organs, which can be extremely painful.

Getting a diagnosis
So what are the telltale signs you have a cyst and should see your doctor? Pelvic pain that may radiate to your lower back and thighs, pressure on your bowels (sometimes extreme, and especially during bowel movements), increased urination (caused by pressure on the bladder), nausea or vomiting, breast tenderness, and pain during intercourse are all symptoms of cysts. If any of the symptoms become severe—especially abdominal or pelvic pain, potentially with a fever or vomiting—you should head to the emergency room. These symptoms may indicate ectopic pregnancy (an embryo implanted in the fallopian tubes), ovarian torsion or a ruptured cyst.

To have a cyst diagnosed, you’ll have a series of tests, including ultrasound and bloodwork. “Ultrasound is a relatively easy imaging option and can usually confirm the diagnosis,” Derrington says. “In a small number of patients where the ultrasound doesn’t give enough information, an MRI is generally the next step.”

Cysts and fertility
A cyst’s influence on your long-term health and your ability to get pregnant depends on many factors, including the cyst type and size, your age and your overall fertility. “Functional cysts don’t usually affect fertility, unless they’re very large,” says Derrington, noting that women who have polycystic ovarian syndrome can experience fertility challenges, too. Endometriomas may also affect your ability to conceive (they can distort the anatomy of your pelvis and cause inflammation and scarring), and you may require treatment—usually laparoscopic surgery if you’re trying to become pregnant, in order to preserve as much of your uterus and ovaries as possible. Dermoid cysts and cystadenomas aren’t associated with infertility.

Treating ovarian cysts
The best treatment depends on the type and size of the cyst, but options include careful monitoring, birth control pills to help slow the growth, or surgery. If the cyst is particularly large, looks concerning on imaging or doesn’t respond to treatment, it may need to be removed. In extreme cases, your doctor may recommend removing the entire ovary, or, if the cyst is cancerous, removing the uterus, ovaries and fallopian tubes.

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