Ovarian Cysts and Pregnancy: Do They Lower Your Chances of Getting Pregnant? Complete Analysis from a Reproductive Medicine Specialist

Q: I have a cyst and I'm trying to get pregnant. Should I worry?

Most likely not. Functional cysts are common and do not affect fertility. It's best to have it evaluated by a doctor, but you generally do not need to put family planning on hold unless specifically advised.

Q: Will cyst removal surgery affect my fertility?

Modern fertility-preserving surgery aims to have minimal impact. Studies show a significant number of women conceive after surgery. The key is ensuring the procedure is performed by an experienced reproductive surgeon and only when medically necessary.

Q: Can I get pregnant if I have PCOS?

Yes, absolutely. While PCOS is a leading cause of infertility, most women with PCOS can achieve pregnancy with appropriate treatment, and success rates with fertility treatments like IVF are excellent.

Q: Should I remove my endometrioma before trying to conceive?

This decision depends on factors like cyst size, symptoms, your age, and ovarian reserve. Small, asymptomatic endometriomas might be monitored, while larger or painful ones may require removal. A consultation with a fertility specialist is crucial.

Q: Are cysts dangerous during pregnancy?

Most cysts found during pregnancy are corpus luteum cysts which support the early pregnancy and resolve on their own. However, monitoring is important as pregnancy slightly increases the risk of ovarian torsion.

Q: How often should cysts be monitored?

Simple cysts under 6 cm can be monitored with ultrasound every 6-12 months. More complex cysts or endometriomas typically require closer follow-up, often every 6 months, until a management plan is decided.

Q: Can birth control pills prevent cysts?

Hormonal birth control prevents the formation of new functional cysts by suppressing ovulation. However, they do not treat or resolve existing pathological cysts like endometriomas or dermoid cysts.

Q: Will removing one ovary cut my fertility in half?

No, this is a common myth. Removing one ovary typically reduces overall fertility by only about 15-20%. The remaining ovary often compensates by ovulating more frequently.

Q: Can stress cause ovarian cysts?

While stress does not directly cause cysts to form, it can disrupt hormonal balances in the body, which can contribute to conditions associated with cysts, like PCOS. Managing stress is beneficial for overall reproductive health.

Most ovarian cysts do not affect your ability to get pregnant. However, certain types of cysts—particularly those associated with endometriosis or PCOS—can impact fertility. This comprehensive guide helps you understand which cysts matter and what steps to take.

What Are Ovarian Cysts: Understanding the Basics

An ovarian cyst is a fluid-filled sac that develops on or inside an ovary. Before you worry, know this: having ovarian cysts is incredibly common. Most women develop them as part of their normal menstrual cycle, and they usually disappear without causing any problems.

"I see patients panic when they hear 'ovarian cyst,' but in my 15 years of practice, I can assure you that the vast majority are completely harmless," explains Dr. Diana Lobzeva. "The key is understanding which type you have."

Dr. Diana Lobzeva

Why Cysts Form

Ovarian cysts develop for various reasons:

Normal ovulation process: Most cysts are part of your body's natural monthly cycle
Hormonal imbalances: Disrupted hormone levels can prevent normal cyst resolution
Underlying conditions: Endometriosis, PCOS, or other medical conditions
Previous infections: Pelvic inflammatory disease can sometimes lead to cyst formation

Types of Ovarian Cysts: Which Ones Matter for Fertility

Understanding cyst types is crucial because they have very different implications for your reproductive health.

Functional Cysts — Normal Part of Your Cycle

Follicular Cysts

Form when a follicle (egg sac) doesn't release its egg during ovulation
Usually disappear within 1-3 months
Size: Typically 2-5 cm
Fertility impact: None — these actually indicate normal ovarian function

Corpus Luteum Cysts

Develop after ovulation when the follicle doesn't dissolve properly
Essential during early pregnancy (produce progesterone)
Usually resolve by 8-10 weeks of pregnancy
Fertility impact: None — may actually support early pregnancy [1]

"Functional cysts are like your ovary's way of showing it's working properly," notes Dr. Diana Lobzeva. "I often tell patients these are 'good cysts' because they mean you're ovulating."

Dr. Diana Lobzeva

Pathological Cysts — Require Monitoring or Treatment

Endometriomas (Chocolate Cysts)

Caused by endometriosis — when uterine lining grows outside the uterus
Filled with old blood, giving them a chocolate-brown appearance
Size: Can range from 2-10+ cm
Fertility impact: Significant — Associated with reduced fertility rates

Research shows women with endometriosis have only a 2-4% chance of conceiving naturally each month, compared to 15-20% for healthy women [2]. This reduction occurs due to:

Inflammation affecting egg quality
Anatomical distortion of reproductive organs
Possible immune system dysfunction
Scarring that can block fallopian tubes

Dermoid Cysts (Teratomas)

Contain tissue types like hair, teeth, or skin
Present from birth but grow slowly
Usually benign but can become large
Fertility impact: Minimal direct effect, but large cysts may require surgery that could affect ovarian reserve

Cystadenomas

Benign tumors filled with watery or mucous-like fluid
Can grow quite large (10-30 cm)
Two types: serous (watery) and mucinous (thick fluid)
Fertility impact: Minimal direct effect, but may require surgical removal if large

PCOS-Related Cysts

Multiple small cysts (2-9 mm) scattered throughout enlarged ovaries
Part of Polycystic Ovary Syndrome
Fertility impact: Major — PCOS is a leading cause of infertility

Women with PCOS often don't ovulate regularly because multiple immature follicles compete but none becomes dominant enough to release an egg [3].

How Ovarian Cysts Actually Affect Fertility

The relationship between cysts and fertility is more nuanced than many people realize.

Cysts That Don't Affect Fertility

Most functional cysts (follicular and corpus luteum) indicate normal ovarian function and don't impair fertility. Recent research confirms that simple ovarian cysts don't significantly impact pregnancy rates in fertility treatments [4].

Small, simple cysts under 6 cm have less than 1% risk of malignancy and typically don't interfere with conception [5].

Cysts That Can Impact Fertility

Endometriomas reduce fertility through multiple mechanisms:

Ovarian reserve damage: Surgery to remove them can inadvertently remove healthy ovarian tissue
Anatomical distortion: Large cysts can compress normal ovarian tissue
Inflammatory environment: Chronic inflammation affects egg quality
Associated adhesions: Scar tissue can block fallopian tubes

PCOS cysts prevent regular ovulation:

Anovulation: No egg release means no chance of natural conception
Hormonal imbalance: Elevated androgens and insulin resistance
Multiple competing follicles: No single dominant follicle develops

"Often, it's not the cyst itself but the treatment that affects fertility," explains Dr. Lobzeva. "Every surgery carries some risk to ovarian reserve, which is why we're very selective about when to operate."

Dr. Lobzeva

The Surgery Factor

Studies show that 48-50% of women who attempt conception after ovarian cyst surgery achieve pregnancy within 18 months [6]. While this is reassuring, it's lower than normal fertility rates, partly due to:

Inadvertent removal of healthy ovarian tissue during surgery
Reduced blood supply to remaining ovarian tissue
Post-surgical adhesion formation

Symptoms You Shouldn't Ignore

Common Cyst Symptoms

Most small cysts cause no symptoms, but larger ones may cause:

Pelvic pressure or fullness
Bloating
Changes in menstrual cycle
Pain during intercourse
Frequent urination (if cyst presses on bladder)

Emergency Warning Signs — Seek Immediate Medical Care

⚠️ Call emergency services if you experience:

Sudden, severe pelvic or abdominal pain
Pain with fever and vomiting
Rapid pulse or dizziness
Cold, clammy skin

These could indicate ovarian torsion (twisted ovary) or cyst rupture — both require immediate surgery.

When to See Your Doctor (Non-Emergency)

Persistent pelvic pain
Irregular menstrual periods
Difficulty getting pregnant after 6-12 months of trying
Unusual bloating or abdominal enlargement
Pain during bowel movements

Modern Diagnosis and Treatment Approaches

Diagnostic Process

Initial Assessment:

Pelvic examination: Manual assessment of ovaries
Transvaginal ultrasound: Most important test for cyst evaluation
Blood tests: Tumor markers (CA-125), hormone levels (LH, FSH, AMH)
MRI: For complex cysts requiring detailed imaging

Fertility-Specific Tests:

AMH (Anti-Müllerian Hormone): Measures ovarian reserve
Antral Follicle Count: Ultrasound count of small follicles
Hormone panel: FSH, LH, estradiol on cycle day 3

Treatment Options

Treatment	Indication	Fertility Impact
Observation	Simple cysts <6cm, asymptomatic	No impact
Hormonal therapy	Functional cysts, PCOS	Can improve ovulation
Laparoscopic cystectomy	Large/symptomatic cysts	Minimal if done carefully
Oophorectomy	Malignant or non-functioning ovary	15-20% fertility reduction

Fertility-Preserving Surgery Techniques

When surgery is necessary, reproductive specialists use techniques to maximize fertility preservation:

Laparoscopic Approach:

Smaller incisions, faster recovery
Better visualization of delicate structures
Reduced adhesion formation

Cyst Enucleation:

Carefully separate cyst from healthy ovarian tissue
Preserve maximum amount of normal ovary
Use minimal electrocautery to prevent thermal damage

Alternative Techniques for endometriomas:

Sclerotherapy: Injection of sclerosing agents
Plasma energy: Vaporization with less tissue damage
Drainage and coagulation: For recurrent simple cysts

Planning Pregnancy with Ovarian Cysts

When Cysts Don't Delay Your Plans

If you have functional cysts or small simple cysts, you can typically:

Continue trying to conceive naturally
Proceed with fertility treatments if needed
Expect normal pregnancy outcomes

When to Consider Fertility Preservation

Before endometrioma surgery, consider egg freezing if:

You're not ready for pregnancy now
You have large or bilateral endometriomas
You have signs of decreased ovarian reserve (low AMH, high FSH)
You're over 35 with fertility goals

"I always discuss egg freezing with my endometriosis patients before surgery," explains Dr. Diana Lobzeva. "While we do everything possible to preserve ovarian tissue, prevention is better than hoping for the best."

Dr. Diana Lobzeva

PCOS and Conception

For women with PCOS-related cysts:

Natural conception: May be possible with:

Weight management (5-10% weight loss can restore ovulation)
Metformin to improve insulin sensitivity
Ovulation induction medications (Clomid, letrozole)

Assisted reproduction: Often very successful with:

Careful ovarian stimulation protocols
Single embryo transfer to avoid multiple pregnancies
High pregnancy rates once eggs are retrieved

IVF Considerations

Recent studies suggest it may not be necessary to remove ovarian cysts before IVF in many cases [7]. Factors influencing this decision include:

Cyst size and type
Ovarian reserve status
Response to previous treatments
Patient age and fertility goals

The Bottom Line: What You Need to Know

Most ovarian cysts are harmless and don't affect your ability to get pregnant
Functional cysts are actually good signs — they mean you're ovulating normally
Endometriosis-related cysts can significantly impact fertility and may require specialized treatment
PCOS is treatable with excellent success rates using modern fertility treatments
Surgery, when necessary, can be fertility-preserving with the right techniques
Don't delay evaluation — early diagnosis leads to better outcomes

When to Consult a Fertility Specialist

Consider seeing a reproductive endocrinologist if you have:

Recurrent pregnancy loss
Difficulty conceiving after 6 months (if over 35) or 12 months (if under 35)
Known endometriosis or PCOS
Large or complex ovarian cysts
Family history of early menopause or ovarian cancer
Previous ovarian surgery

"The most important thing I tell my patients is not to panic," concludes Dr. Diana Lobzeva. "Modern reproductive medicine has excellent solutions for virtually every cyst-related fertility concern. The key is getting accurate information and appropriate care."

Dr. Diana Lobzeva

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FAQs

I have a cyst and I'm trying to get pregnant. Should I worry?

Most likely not. Functional cysts are common and don't affect fertility. Have it evaluated by your doctor, but don't put your family planning on hold unless specifically advised.

Will cyst removal surgery affect my fertility?

Modern fertility-preserving surgery has minimal impact on fertility. Studies show 48-50% of women conceive within 18 months after surgery. The key is having surgery performed by an experienced reproductive surgeon when truly necessary.

Can I get pregnant if I have PCOS?

Yes, absolutely. While PCOS is a leading cause of infertility, most women with PCOS can achieve pregnancy with appropriate treatment. Success rates with fertility treatments are excellent.

Should I remove my endometrioma before trying to conceive?

This decision depends on multiple factors including cyst size, your symptoms, ovarian reserve, and age. Small, asymptomatic endometriomas might be monitored, while large or painful ones may benefit from removal.

Are cysts dangerous during pregnancy?

Most cysts during pregnancy are corpus luteum cysts that support early pregnancy and resolve naturally. However, pregnancy increases the risk of ovarian torsion by 5 times, so monitoring is important [8].

How often should cysts be monitored?

Simple cysts under 6 cm can be monitored with ultrasound every 6-12 months. Complex cysts or endometriomas typically require follow-up every 6 months until surgically managed.

Can birth control pills prevent cysts?

Hormonal birth control can prevent functional cysts by suppressing ovulation, but they don't treat existing pathological cysts like endometriomas or dermoids.

Will removing one ovary cut my fertility in half?

No, this is a common myth. Removing one ovary typically reduces fertility by only 15-20%, not 50%. The remaining ovary often compensates by producing more eggs.

Can stress cause ovarian cysts?

While stress doesn't directly cause cysts, it can affect hormone levels and potentially contribute to conditions like PCOS. Managing stress through healthy lifestyle choices is beneficial for overall reproductive health.

Sources and References

[1] National Center for Biotechnology Information. Ovarian Cyst. StatPearls. 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560541/

[2] Extend Fertility. How do ovarian cysts affect fertility? 2019. Available at: https://extendfertility.com/how-do-ovarian-cysts-affect-fertility/

[3] Concept Fertility. What Are the Effects of Ovarian Cysts on Fertility? 2024. Available at: https://www.conceptfertility.co.uk/2024/05/14/what-are-the-effects-of-ovarian-cysts-on-fertility/

[4] PMC. The Effect of Baseline Ovarian Cyst on Pregnancy Outcomes in Ovulation Induction/Intrauterine Insemination Cycles. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10890952/

[5] Medical News Today. Ovarian cysts: Can they affect fertility? 2024. Available at: https://www.medicalnewstoday.com/articles/can-you-get-pregnant-with-ovarian-cyst

[6] PMC. The Risk of Infertility After Surgery for Benign Ovarian Cysts. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10171942/

[7] PubMed. The Risk of Infertility After Surgery for Benign Ovarian Cysts. 2023. Available at: https://pubmed.ncbi.nlm.nih.gov/36971598/

[8] PMC. The influence of ovarian cyst type and size on ovarian reserve markers: implications for fertility counseling and preservation strategy. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12178891/

[9] Legendre G, et al. Relationship between ovarian cysts and infertility: what surgery and when? Fertil Steril. 2014;101(3):608-14. Available at: https://pubmed.ncbi.nlm.nih.gov/24559614/

[10] Mayo Clinic. How ovarian cysts affect fertility. 2024. Available at: https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/expert-answers/ovarian-cysts-and-infertility/faq-20057806