Ovarian cysts are a common concern for many individuals, especially those navigating their fertility journey. Dr. Sara Arian, a double board-certified reproductive endocrinology and fertility specialist at Boston IVF, frequently addresses questions about ovarian cysts, their types, and their impact on reproductive health. In this blog, we will explore the various types of ovarian cysts, their symptoms, and how they may affect fertility.

What Are Ovarian Cysts?
An ovarian cyst is a fluid-filled sac that forms inside or on an ovary. While cysts can develop anywhere in the body, ovarian cysts are particularly significant due to their potential impact on reproductive function. These cysts can be categorized as benign (non-cancerous) or malignant (cancerous). This article focuses primarily on benign ovarian cysts, their characteristics, and management.

Types of Benign Ovarian Cysts
1. Functional Ovarian Cysts
Functional ovarian cysts are the most common type and develop as part of the natural menstrual cycle. They are also known as simple ovarian cysts. During ovulation, a follicle forms and grows under hormonal signals from the brain. If this follicle fails to rupture and release an egg, it can turn into a cyst.

• Symptoms: Often asymptomatic, but may cause mild pelvic discomfort.
• Treatment: Most resolve on their own, but larger or persistent cysts may require monitoring through ultrasounds. Hormonal contraceptives may sometimes be used to suppress ovulation and prevent new cyst formation.

2. Hemorrhagic Ovarian Cysts
A hemorrhagic cyst occurs when bleeding occurs within a follicle or functional cyst. These cysts are also typically harmless but can cause discomfort.

• Symptoms: Mild pelvic pain, but in rare cases, severe abdominal pain, nausea, or vomiting may occur if the cyst ruptures.
• Treatment: Most hemorrhagic cysts resolve on their own, but surgical removal may be necessary if there is a risk of rupture or ovarian torsion (twisting of the ovary).

3. Dermoid Cysts (Ovarian Teratomas)
Dermoid cysts are unique because they develop from germ cells and can contain different types of tissues, including hair, skin, cartilage, and fat.

• Symptoms: Usually asymptomatic but may cause pelvic pain or pressure if they grow large.
• Treatment: Surgical removal may be recommended if the cyst continues to grow, becomes symptomatic, or poses a risk of ovarian torsion.

4. Endometriomas (Chocolate Cysts)
Endometriomas are associated with endometriosis, a condition where endometrial tissue grows outside the uterus. When this tissue accumulates in the ovaries, it forms dark, blood-filled cysts known as chocolate cysts.

• Symptoms: Chronic pelvic pain, painful intercourse, discomfort during bowel movements, and potential fertility issues.
• Treatment: Management varies; surgical removal may be necessary for large cysts, but surgery should be carefully considered as it may reduce ovarian reserve.

5. Polycystic Ovarian Morphology and PCOS
Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects ovulation. On ultrasound, individuals with PCOS often have multiple small follicles that resemble cysts, but these are actually immature eggs.

• Symptoms: Irregular periods, excessive hair growth, acne, weight gain, and infertility.
• Treatment: Lifestyle modifications, hormone therapy, and medications like ovulation inducers may help manage symptoms and improve fertility.

How Are Ovarian Cysts Diagnosed?
Ovarian cysts are typically detected through:

• Pelvic exam: A routine check-up may reveal an enlarged ovary or cyst.
• Ultrasound: The most common imaging tool to assess the size, shape, and characteristics of a cyst.
• CT scan or MRI: Used in rare cases to obtain a more detailed evaluation.

When Do Ovarian Cysts Require Treatment?
Most ovarian cysts are harmless and resolve on their own. However, medical intervention may be necessary if:

• The cyst is large (greater than 5-7 cm).
• The individual experiences persistent pain, bloating, or irregular menstrual cycles.
• There is suspicion of ovarian torsion, which is a medical emergency.
• The cyst appears suspicious for malignancy, especially in postmenopausal individuals.

Can Ovarian Cysts Affect Fertility?
While most benign ovarian cysts do not interfere with fertility, some conditions, such as endometriomas and PCOS, can impact egg quality and ovulation. It is essential to discuss an individualized fertility management plan with a reproductive specialist.

Conclusion: Consult a Specialist
If you have been diagnosed with an ovarian cyst or are experiencing symptoms, it is crucial to consult a fertility specialist. Understanding the nature of ovarian cysts and their potential impact on reproductive health will empower you to make informed decisions about your fertility journey.