Ovarian Cysts & Fertility Symptoms, Diagnosis & Treatment

Ovarian cysts are among the most common gynecological findings. In many cases, they go unnoticed, while in others, they can cause cycle disruptions, pain, or difficulty conceiving. If you're wondering how ovarian cysts affect fertility or what the appropriate treatment is before an IVF attempt, being well-informed is the first step. At Fertulity, we deeply explore the relationship between ovarian cysts and fertility, offering personalized solutions and specialized medical guidance.

What are ovarian cysts?

Ovarian cysts are small fluid-filled sacs that form on or inside the ovaries. They are a common occurrence in women of reproductive age and are usually benign and temporary. However, in certain cases, they may cause symptoms or affect fertility, especially when associated with endometriosis or polycystic ovaries. Early diagnosis and evaluation of the cyst type are crucial for a woman's health and family planning.

Functional cysts

Functional cysts are the most common and are related to the normal function of the ovarian cycle. They mainly include follicular cysts and corpus luteum cysts, occurring when follicle rupture or absorption does not occur normally. They usually cause no symptoms and resolve spontaneously within 1–2 cycles. Despite their frequency, they aren't considered threatening to fertility unless they recur frequently or disrupt ovulation.

Pathological cysts (endometriomas, dermoids, etc.)

Pathological cysts are abnormal structures often requiring monitoring or surgical removal.

Endometriomas (chocolate cysts): Associated with endometriosis, containing old blood. They can directly affect fertility due to inflammation and adhesions.

Dermoid cysts (mature teratomas): Benign tumors containing tissues such as hair, fat, or teeth. They aren't necessarily linked to fertility but usually require removal due to risk of torsion.

Cystadenomas: Cysts originating from epithelial cells that may grow large, causing pressure on nearby organs.

Differential diagnosis is crucial to determine the appropriate therapeutic approach and avoid conception complications.

When is a cyst considered serious?

An ovarian cyst is considered serious when:

It persists for more than 2–3 months without resolution

It grows larger or causes pain

It is accompanied by menstrual irregularities

It shows suspicious features on ultrasound (e.g., solid elements, septations)

It coexists with elevated markers (e.g., CA-125)

Evaluation by a gynecologist and the use of high-resolution ultrasound are necessary steps to exclude pathology and select the appropriate management.

Schedule an ultrasound and find out what the cyst means for your fertility.

Book a check-up today

How do ovarian cysts affect fertility?

Ovarian cysts aren't always threatening to fertility, but certain types can significantly impact a woman's ability to conceive. Depending on the nature, size, and position of the cyst, either hormonal balance or the normal functioning of reproductive organs can be affected, leading to delayed conception or the need for assisted reproduction.

Hormonal axis & ovulation

Certain cysts, such as those associated with polycystic ovary syndrome (PCOS) or the presence of endometriomas, can disrupt the normal hypothalamic–pituitary–ovarian hormonal axis. This results in irregular or absent ovulation (anovulation), reducing the chances of natural conception. Often, a woman may have regular periods without ovulation, a situation frequently overlooked without proper evaluation.

Mechanical restrictions of the fallopian tubes

Cysts developing in association with endometriosis or post-surgical adhesions may cause mechanical obstruction or limit fallopian tube mobility. Fallopian tubes play a vital role in transporting the egg and fertilized blastocyst to the uterus. When this function is hindered, the chance of natural conception significantly decreases or becomes impossible, often leading to the need for IVF.

Symptoms & Diagnostic Methods

Ovarian cysts may be asymptomatic or cause various symptoms, depending on their size, location, and type. Early recognition of signs and proper diagnostic approach are critical both for general health and fertility. A combined clinical examination, imaging methods, and hormonal/biochemical markers lead to reliable diagnosis and appropriate management.

Pain / Irregular cycles

Common ovarian cyst symptoms include lower abdominal pain, either persistent or cyclic, which may intensify during ovulation or menstruation. Many women also experience irregular or prolonged cycles, intermenstrual bleeding, or even absent periods (amenorrhea). These symptoms shouldn't be ignored, as they may indicate a cyst disrupting the normal ovarian cycle.

Ultrasound

Pelvic ultrasound (abdominal or transvaginal) is the primary imaging method for ovaries and cysts. It provides information about cyst size, shape, consistency, and structure (e.g., simple or multilocular). It is painless, accessible, and can be performed at any cycle phase, with significant diagnostic value if repeated in successive cycles for monitoring.

AMH, CA-125, MRI

In complex cases, laboratory and imaging tests enhance diagnostic accuracy:

AMH (Anti-Müllerian Hormone): Indicator of ovarian reserve. Low levels may suggest reduced egg reserve, often influenced by endometriomas.

CA-125: Cancer marker potentially elevated in cases of endometriosis or malignancy, but not specific.

MRI: Offers detailed imaging, especially in endometriosis or complex cyst cases, aiding in distinguishing benign from suspicious lesions. A comprehensive diagnostic approach is essential for proper treatment planning, whether natural conception or assisted reproduction is intended.

Treatment Options for Ovarian Cysts

Ovarian cyst treatment depends on several factors: cyst type, size, symptoms, woman's age, and family planning goals. The goal is to manage the cyst while preserving or restoring fertility whenever necessary.

Monitoring & medication

Simple, functional cysts are usually monitored with repeat ultrasounds every 6–8 weeks, resolving spontaneously in most cases. In selected cases, oral contraceptives may be prescribed to regulate the cycle and prevent new cyst formation. This approach suits asymptomatic women not immediately seeking pregnancy without suspicious imaging findings.

Laparoscopic removal

Minimally invasive laparoscopic surgery is preferred for pathological cysts, such as endometriomas, dermoids, or large symptomatic cysts. It offers precision, faster recovery, and preservation of ovarian function when performed by an experienced gynecologist. Surgery should aim to preserve maximum healthy ovarian tissue, especially in women desiring pregnancy.

IVF after cyst removal

In cases where a cyst has compromised ovarian function or adhesions complicate natural conception, IVF may be the most effective solution. For women with endometriosis or low ovarian reserve, timely transition to IVF after cyst removal significantly improves pregnancy chances. Strategies are individualized based on age, hormonal profile, and goals.

Prevention & Healthy Lifestyle

Although preventing ovarian cysts isn't always possible, practical steps can reduce risk or enable early detection. A healthy lifestyle combined with regular medical monitoring significantly contributes to hormonal balance, ovarian function, and overall reproductive health.

Antioxidant-rich diet

A diet rich in fiber, fruits, vegetables, healthy fats (like omega-3 fatty acids), and antioxidants is linked to better endocrine function. Foods like leafy greens, berries, nuts, green tea, and olive oil support anti-inflammatory effects and hormonal regulation. Conversely, excessive processed foods and sugar may intensify hormonal instability, contributing to cyst formation.

Weight management & PCOS

Maintaining a healthy body weight is crucial for women with polycystic ovaries (PCOS), as increased body fat worsens insulin resistance and symptoms. Regular exercise, balanced diet, and avoiding sedentary habits help control weight and hormonal function. Even moderate weight loss (5–10%) can restore ovulation and reduce cyst recurrence.

Regular gynecological check-up

Preventive gynecological evaluation, even without symptoms, is essential for early diagnosis of cysts and other gynecological issues. Annual or more frequent ultrasounds in women with relevant history allow prompt management of ovarian changes before fertility is affected. Prevention is always preferable and the cornerstone of reproductive care.

Frequently Asked Questions About Ovarian Cysts

Can ovarian cysts recur after removal?

Yes, in certain cases, cyst recurrence is possible, especially for functional cysts or if the underlying cause (such as endometriosis or PCOS) hasn't been managed hormonally or through lifestyle changes. Regular monitoring after removal is essential to prevent future recurrences.

What are the signs of an ovarian cyst rupture, and what should I do?

A cyst rupture may cause sudden, intense lower abdominal pain, sometimes accompanied by nausea, sweating, or fainting. If you notice such symptoms—particularly if severe or accompanied by bleeding—immediate medical evaluation is required, as urgent intervention may be necessary.

Can ovarian cysts affect menopause?

Most cysts are more common in women of reproductive age, but some may occur during perimenopause. In menopause, cyst appearance requires special attention and evaluation for potential malignancy, especially if it persists or has suspicious ultrasound features.

Can a woman with ovarian cysts conceive naturally?

Yes, many women with ovarian cysts conceive naturally, particularly when cysts are small, functional, and do not affect ovulation or fallopian tube structure. However, in cases of endometriosis, PCOS, or large cysts, medical support or IVF may be necessary.

Is there a natural treatment for ovarian cysts?

While no scientifically proven natural treatment replaces medical or surgical interventions, certain lifestyle changes—such as an anti-inflammatory diet, stress reduction, and physical exercise—can help regulate hormones and reduce the risk of new cyst formation. Always seek guidance from a gynecologist.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Maria Oikonomou Obstetrician – Gynecologist

See Full CV

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I