Ovarian cysts: Can they affect fertility?

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Ovarian cysts are symptoms, not conditions in themselves. Cysts measuring less than 10 centimeters (cm) are unlikely to cause functional problems. Most ovarian cysts do not lead to problems conceiving.

However, some people experience fertility issues due to ovarian cysts. This generally depends on the type of ovarian cyst.

Functional ovarian cysts relate to the menstrual cycle. Eggs develop in a part of the ovary called a follicle. If a follicle does not release an egg or does not clear its fluid and shrink in size after releasing an egg, a cyst can develop. These are usually harmless but sometimes cause symptoms. Most resolve without treatment after a few months.

Pathological cysts occur due to abnormal cell growth. Many are noncancerous (benign) but occur for reasons that do not relate to the menstrual cycle, such as PCOS, endometriosis, and, rarely, ovarian cancer.

Doctors may need to remove pathological cysts, which can increase the risk of fertility effects. A 2023 study examined the links between ovarian cyst removal surgery and infertility in 1,537 women ages 22–45 years. Those who had received ovarian cyst surgery were more likely to report a medical history of infertility than those who did not undergo ovarian cyst removal.

Cyst removal may affect a person’s ovarian reserve — the number of eggs they have left to release during ovulation. However, the following complications of cysts may mean that ovary removal is the best choice for overall health:

• ovarian torsion, in which an ovary becomes twisted around its supportive tissue
• long-term presence of cysts
• severe abdominal pain
• possible or confirmed ovarian cancer

However, the study also highlighted that conditions requiring cyst removal as a treatment may also directly contribute to infertility. Surgeons will take measures to protect fertility where possible during surgery. However, if they need to remove both ovaries, pregnancy will not be possible.

Read more about ovarian cysts.

PCOS can lead to many cysts developing on the ovaries and is also the most common cause of infertility in females, according to the World Health Organization (WHO). The WHO estimates that 8–13% of reproductive-age females develop PCOS but that 70% of females with the condition are undiagnosed.

There is no cure for PCOS. The condition can lead to imbalanced hormones, high levels of the male sex hormone androgen, and irregular periods that do not lead to the release of an egg. It is not the cysts themselves that affect fertility but the lack of egg release due to the underlying PCOS.

Females who experience fertility problems alongside regular acne and excessive hair growth may wish to speak with a healthcare professional about PCOS.

Medications and surgery are available to help the ovaries release eggs, although healthcare professionals may first recommend regular exercise and a nutritious diet to see if this helps.

Read more about PCOS.

Endometriosis is another condition with strong links to both ovarian cysts and infertility. The condition causes tissue similar to what usually grows in the womb lining to develop outside the womb, causing inflammation and scarring around the pelvis.

Cystic ovarian endometriosis is a type of endometriosis that can cause tissue similar to the lining of the womb to develop on the ovaries and form cysts. People with endometriosis might experience pelvis pain during a period, while having sex, or while passing stools or urine. Infertility is also a common symptom. However, not everyone with endometriosis will experience infertility.

A 2020 review estimates that 30–50% of people with endometriosis experience infertility. Cystic ovarian endometriosis can lead to both cysts and infertility, but that does not mean the cysts are the direct cause of infertility. With endometriosis and PCOS, the underlying condition is largely responsible for fertility problems.

Rarely, ovarian cysts can also be cancerous or become cancerous over time. This may mean that treatment involves the removal of one or both ovaries for some people, potentially affecting fertility.

Two different types of functional ovarian cysts may develop as part of ovulation when the ovaries release an egg. These are known as follicular cysts and corpus luteal cysts.

Before ovulation, a follicular cyst forms to protect an egg while it develops. However, if the egg does not release or mature properly, the cyst can remain. Around 70–80% of follicular cysts resolve without treatment within 1–3 months and do not cause functional problems.

A corpus luteal cyst may develop if the corpus luteum — a group of cells that make hormones to support pregnancy — does not shrink away within 14 days of an unsuccessful egg release.

For most females, neither of these typically contributes directly to fertility problems.

The United Kingdom’s National Health Service (NHS) advises that recovery times are different for every individual who has cyst removal surgery. It suggests that a person may resume normal activities in 12 weeks, although this does not specify a likely time for pregnancy.

A 2023 study tracked 102 females looking to become pregnant following ovarian cystectomy due to endometriosis. The study found that it took an average of 10 months to become pregnant after this procedure for the 69.9% of individuals who conceived.

The following are questions people frequently ask about ovarian cysts and pregnancy.

Can ovarian cysts cause miscarriage?

Ovarian cysts often occur during pregnancy, and many do not cause problems for the pregnant person or fetus. Cysts support early pregnancy by releasing hormones until the placenta develops. If the cyst is still on the ovary in later pregnancy, a surgeon may need to remove it.

However, complications such as ovarian torsion may become five times more likely during pregnancy, according to a 2023 case study. These can increase the risk of harm to the developing embryo.

Can a person have IVF with ovarian cysts?

Research is mixed. Earlier studies have linked having an ovarian cyst with poor in vitro fertilization (IVF) outcomes. However, a 2022 study of over 3,300 cycles found that it might not be necessary to remove ovarian cysts before IVF or cancel IVF cycles if a functional ovarian cyst is present.

People who have a diagnosis of ovarian cysts should speak with their IVF specialist about the likelihood of success, considering their overall health, the cause and size of their cysts, and the method of IVF they are attempting.

For example, females with cysts due to moderate-to-severe endometriosis might have a lower chance of pregnancy than those who receive IVF and do not have the condition.

Will an ovarian cyst cause a positive pregnancy test?

Pregnancy tests detect increased levels of human chorionic gonadotropin (hCG), an important pregnancy hormone. Conditions causing excess hCG can lead to a false positive on a pregnancy test, according to a 2023 review.

A corpus luteal cyst releases hCG to support pregnancy, so it might lead to a positive result even though no pregnancy develops. However, this is rare.

Many ovarian cysts do not affect fertility. Most functional ovarian cysts develop during menstruation and resolve without causing symptoms.

However, some occur due to conditions such as PCOS or endometriosis that directly reduce fertility.

Some studies have shown that surgeries to remove ovarian cysts might also affect fertility. If both ovaries need removing, it will not be possible to conceive.

Individuals with concerns about ovarian cysts or fertility should speak with a healthcare professional.