Friday, January 14, 2022

Ovarian cysts and infertility - what every patient needs to know


Ovarian cysts are extremely common in women in the reproductive age group of between 20 to 40 . Because they are common in fertile women, they are obviously common in infertile women as well .

However , the problem is that whenever an infertility specialist sees an ovarian cyst in an infertile woman , patients tend to put two and two together , and blame the ovarian cyst for the infertility . They naively believe the cyst is responsible for the infertility, and if the doctor treats it properly , she will get pregnant.

 The problem is compounded by the fact that many doctors also believe this. Sadly, they don’t bother to explain to patients how common cysts are, and that most cysts are physiological or functional, and don’t need any treatment as all. They are usually incidental findings, and can be left alone.

 Technology has actually made this problem worse. Ultrasound has become cheap and ubiquitous , and every infertile woman is subjected to a routine ultrasound scan.

Because the machines are so good, we can easily pick up cysts which are as small as 10 mm/ 1 cm.

 This is the size of a small marble, and is of no clinical importance ! Remember that a mature ovarian follicle is also about 20 mm in size .

However, sonographers will document this, and underline this finding in red / bold.

This will cause the patient to panic ! The other problem is that sonographers report sizes in mm instead of cm, so that it appears more significant ! Instead of saying the patient has a 4 cm size cyst, they will say the patient has a 40 mm cyst .  Most patients are mathematically challenged, and start worrying if this is a tumour or a cancer.

Bad doctors compound this problem by telling the patient that if we don't do anything , this will become larger , or will become cancerous , or will burst and lead to complications. They scare the patient and cause them to panic.

Most cysts don’t need any treatment at all because they will resolve on their own . These are called functional or physiological ovarian cysts . For example, the follicle may not rupture at the time of ovulation, and may form a corpus luteum cyst.

The real danger of these cysts us that trigger-happy doctors end up over treating it . They often advice surgery to remove the cyst , but this can actually increase the chances of the patient becoming infertile, because whenever they remove the cyst, they also remove normal ovarian tissue , and this reduces the patient’s ovarian reserve .

Other doctors will try to “ suppress “ the cyst with medical therapy - for example , with birth control pills . This is completely pointless , because putting an infertile patient on birth control pills means she can't get pregnant while taking them !

This is why it’s so important that you be well-informed, and don’t let the doctor subject you to unnecessary treatment.

The other common kind of cyst is called a chocolate cyst or an endometrioma. This is a common finding in young women , and just because the doctor sees what he thinks is a chocolate cyst doesn't mean that you need to allow him to remove it .

To add to the confusion, many patients don't understand the difference between an ovarian cyst and PCOD ( polycystic ovarian disease). These are very different  conditions !

While it’s true that the definitive solution for treating a cyst is removing it via surgery, often the surgery is not a good idea . It subjects you to the risks of surgery and anesthesia, and reduces your fertility by reducing your ovarian reserve and causing scar tissue ( adhesions).

Also, the surgery cannot prevent a new cyst from forming, and many of these cysts will recur after the surgery, so the poor patient is back to square one, after wasting a lot of time, money and energy !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

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