Can I proceed with fertility treatments with a large ovarian cyst?

Management of Fertility Treatments with an Ovarian Cyst

The presence of a large ovarian cyst does not necessarily prevent fertility treatments, but management depends on the type, size, and characteristics of the cyst. The decision should be based on careful evaluation of the cyst's features and potential risks.

Assessment of Ovarian Cysts

• Simple cysts up to 10 cm in premenopausal women are likely benign and can be safely monitored without surgical intervention 1
• According to the Ovarian-Adnexal Reporting and Data System (O-RADS), simple cysts less than 3 cm are considered physiological (O-RADS 1) with 0% probability of malignancy 2
• Larger simple cysts (>5 cm but <10 cm) in premenopausal women should have follow-up ultrasound in 8-12 weeks to confirm their functional nature or to assess for cyst wall abnormalities 1
• If the cyst persists or enlarges after follow-up, management by a gynecologist is recommended 1

Impact on Fertility Treatments

• Most functional ovarian cysts resolve spontaneously within a few menstrual cycles without treatment 3
• Watchful waiting is as effective as hormonal treatment for functional ovarian cysts 4, 3
• The relationship between ovarian cysts and infertility is controversial, and surgical treatment often does not improve pregnancy rates 5
• Surgical intervention may potentially be more harmful to ovarian reserve than the cyst itself 5

When to Proceed with Fertility Treatments

• Small asymptomatic cysts (<5 cm) should not delay fertility treatments, especially in women over 35 years 6
• For large cysts (>4 cm), surgical treatment may be considered due to risk of rupture or torsion before proceeding with fertility treatments 6
• If the cyst is determined to be a simple functional cyst, fertility treatments can generally proceed with appropriate monitoring 1

When to Consider Surgery Before Fertility Treatments

• If the cyst has suspicious features on ultrasound (O-RADS 3 or higher) suggesting potential malignancy 1
• If the cyst is very large (>10 cm) and may interfere with oocyte retrieval 6
• If the cyst is causing symptoms such as pain or pressure 6
• If the cyst is an endometrioma in a woman who has failed to conceive after 1-1.5 years of trying 6

Surgical Approach if Needed

• Conservative laparoscopic approach is preferred to preserve ovarian tissue 5
• For presumed benign ovarian tumors, fertility sparing should be the main concern 5
• Techniques like sclerotherapy and plasma vaporization may offer greater preservation of ovarian parenchyma 5

Important Considerations

• The timing of fertility treatment may need to be adjusted to allow for appropriate monitoring of the cyst 1
• Transvaginal ultrasound is the preferred imaging modality for follow-up of ovarian cysts 2
• For larger cysts approaching 10 cm, a transabdominal examination may be necessary for complete evaluation 2
• Avoid overtreatment of simple cysts, as evidence shows they rarely represent malignancy 2

In summary, if your cyst is determined to be a simple functional cyst without suspicious features, you can likely proceed with fertility treatments while monitoring the cyst. However, if the cyst is large (>4 cm), has suspicious features, or is causing symptoms, your doctor may recommend addressing the cyst before proceeding with fertility treatments.