Can Ovarian Cysts Lead to Infertility?

What are ovarian cysts, and can they impact fertility outcomes? Explore causes, symptoms, and treatment of ovarian cysts and what they mean for your fertility.

By Dr. Kenosha Gleaton, OBGYN and fertility expert

Did you know that many ovarian cysts form as a result of a normal menstrual cycle? While they may sound scary and dangerous, most ovarian cysts go away on their own and are relatively harmless. It’s estimated that about 10-20% of people assigned female at birth will have ovarian cysts at some point in their lifetime [2-3]. Let’s talk about how ovarian cysts relate to fertility. 

What are ovarian cysts?

A cyst is a pocket of tissue or a sac that may be filled with fluid, air, or another substance. A lot of people hear the term “cyst” and think that they are inherently bad or have negative health effects. The truth is many ovarian cysts form as a normal part of the menstrual cycle and can be harmless. There are two categories of ovarian cysts: functional (the usually harmless kind) and non functional. 

Functional cysts

Functional cysts are the more common type of ovarian cyst and occur as a result of the normal reproductive cycle. Functional cysts can be formed a few different ways [1-2]:

1. Follicular cyst- the ovarian follicle doesn’t break open to release an egg around ovulation and the follicle continues to grow as a cyst. 

2. Corpus luteum cyst- also referred to as luteal cysts, these form after an egg has been released, but the follicle reseals itself rather than shrinking. Corpus luteum cysts produce a hormone known as progesterone. 

3. Theca lutein cyst- these are formed as a result of elevated human chorionic gonadotropin (hCG) levels. These can occur in pregnant women, ovarian hyperstimulation (a side effect from some fertility medications), and other conditions.

In most cases, functional cysts aren’t likely to cause harm and will go away on their own within a few months [1-2]. Some conditions such as polycystic ovary syndrome (PCOS) may involve multiple ovarian cysts (polycystic ovaries) which typically arise from functional cysts. PCOS can impact fertility and make it more difficult to conceive, but having PCOS and having ovarian cysts are not the same thing [3]. We’ll get into this more later. 

Non functional and potentially harmful cysts

Cysts that aren’t formed as a result of the normal reproductive cycle are known as nonfunctional cysts. These are less common, but may have more of an impact on your health and fertility. Some examples of non functional cysts include [1-2]:

1. Dermoid cysts- these are sometimes present from birth and arise from non-cancerous growths. Dermoid cysts can become malignant in some cases. 

2. Endometriomas-  these can be found in those with endometriosis. Endometriomas arise from the growth of endometrial tissue outside of the uterus. Sometimes the term “chocolate cyst” is used as these can contain dark, thick, and aged blood. 

There are plenty of other non functional cysts that can arise and may or may not be cancerous. Some cysts will go away without treatment, while others may require surgery. It’s also possible for cysts to rupture or twist, which can be painful and dangerous [2]. 

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Symptoms of ovarian cysts 

Symptoms of ovarian cysts can vary. It’s possible to not experience any symptoms at all, while others may experience pain or pressure in the abdomen, spotting or menstrual cycle irregularities, and potentially a swollen stomach or pain when urinating, although this is usually related to very large cysts and isn’t common [2]. If a cyst is to rupture, there may be sudden pain, cramping, nausea, and vomiting [2]. Most individuals with ovarian cysts don’t know they have them, and the cysts will eventually go away on their own. If you’re having very irregular periods, or notice other symptoms related to hormonal imbalances, you should speak with your healthcare provider about PCOS. 

Ovarian cysts vs PCOS

So what is the difference between ovarian cysts and PCOS? In order to diagnose PCOS, there are specific criteria that must be met. Two out of three specific symptoms must be met, which include polycystic ovaries, irregular menstrual cycles, and increased androgen levels (male hormones) [4]. Not all individuals with PCOS will have polycystic ovaries, although it is a common symptom. Additionally, having one or two ovarian cysts is not usually an indication that someone has PCOS, especially because functional cysts are relatively common and are the result of functioning ovulation or menstrual cycle [1-2]. 

PCOS can make it difficult for some to conceive due to the irregular menstrual cycles and hormonal imbalances. There is no way to prevent PCOS or ovarian cysts, but there are ways to manage both. Read more about PCOS on the Natalist blog. 

Do ovarian cysts impact fertility?

Major causes of infertility include lifestyle factors, age, hormonal imbalances, and structural problems [5]. The majority of ovarian cysts that aren’t related to an underlying condition are not likely to impact fertility. The most common type of ovarian cysts are functional cysts that arise on their own and usually resolve on their own without treatment. If cysts are cancerous, growing extremely large, or are related to conditions such as endometriosis or PCOS, there is a chance that fertility will be impacted. There are some fertility treatment options such as ovulation induction that may be useful for those needing assistance with regular ovulation. You should talk to your healthcare provider specifically about your concerns to determine if any treatment is necessary. 

The bottom line

When it comes to your fertility, it’s not so much the ovarian cysts that may have an impact, but what’s causing the cysts. Ovarian cysts can form as a result of the normal menstrual cycle or they may be caused by underlying disorders such as endometriosis or PCOS. Some underlying causes of ovarian cysts may make it more difficult to conceive. Ovarian cysts often go away on their own without treatment and are expected to occur in up to 20% of those assigned female at birth at some point in their lives [1-2]. If you’re experiencing symptoms such as a fever, pain, nausea, abnormal bleeding, etc., then you should see a healthcare provider right away. 

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References:

1. Mobeen S, Apostol R. Ovarian Cyst. [Updated 2022 Jun 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 
2. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Ovarian cysts: Overview. 2019 Mar 28.
3. Collée J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecol Endocrinol. 2021;37(10):869-874. doi:10.1080/09513590.2021.1958310
4. Bani Mohammad M, Majdi Seghinsara A. Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pac J Cancer Prev. 2017;18(1):17-21. Published 2017 Jan 1. doi:10.22034/APJCP.2017.18.1.17
5. Deshpande PS, Gupta AS. Causes and Prevalence of Factors Causing Infertility in a Public Health Facility. J Hum Reprod Sci. 2019;12(4):287-293. doi:10.4103/jhrs.JHRS_140_18