Ovarian Cysts and Pregnancy, How They Affect Fertility
When a woman encounters obstacles in becoming pregnant, she begins to undergo a series of routine checks to try to understand the cause. Many wonder if ovarian cysts can affect pregnancy and fertility in general.
Ovarian cysts are nothing but accumulations of fluid enclosed in small sacs that develop within the ovaries. Most of these cysts are harmless and are small in size, so they do not affect the proper functioning of the woman’s uterus. Others, however, could cause problems if they were to break open and not get absorbed, creating hemorrhages and a lot of pain. In these cases, it may even be necessary to undergo laparoscopic surgery to remove this tissue.
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What exactly are ovarian cysts?
As we just mentioned, ovarian cysts are nothing but sacs containing fluid that form inside the uterus mainly in fertile age. In women, this formation is very common; during the ovulation process, in fact, the uterus releases many follicles, but only one of these will be mature and ready to “host” a pregnancy. All the others that have formed and are not mature, break open naturally; if this does not happen, they can give life to the phenomenon of follicular cysts. Most of these actually get expelled through the menstrual cycle or the body reabsorbs them spontaneously.
Another event also very common in women of fertile age is the formation of corpus luteum cysts, which occur after the release of the follicle. Then there are three types of more serious cysts: dermoid cysts or teratomas, endometriomas, and cystadenomas. While the first types tend to be absorbed spontaneously, cystadenomas are almost always benign tumors, and it will be necessary to intervene either surgically or through appropriate medications indicated by the gynecologist.
To understand what type of cyst has formed, one must undergo a transvaginal ultrasound, which could also identify a polycystic ovary syndrome; this is a clinical situation in which one or both ovaries have multiple cysts and follicles of a diameter ranging from 2 to 6 millimeters inside them.
In most cases, the “more common” cysts do not affect pregnancy. Indeed, researchers have found that in the presence of ovarian tumors, the cysts were almost always benign. However, let’s see what are the cases in which a cyst can really affect fertility.
When are cysts dangerous?
During the initial period of gestation, specifically before the twelfth week, the corpus luteum produces hormones that are tasked with lining the uterus and nourishing the child; this continues until the placenta is adequately developed and able to autonomously protect the fetus. However, in some cases, the corpus luteum fills up with fluid that does not get reabsorbed, which is why cysts form.
In the event of pregnancy, when this phenomenon occurs, the woman’s fertility is put at risk, especially if the future mother was not aware of this or other phenomena, such as polycystic ovary and endometriosis. The latter is a benign chronic inflammation of the female genital organs and the peritoneum, which are lined by endometrial cells, that are normally found only exclusively in the uterus. Unfortunately, endometriosis is an asymptomatic pathology, and women often underestimate it as the classic symptoms are severe pain during the menstrual cycle and during sexual intercourse.
What happens if a cyst is discovered during pregnancy?
If with endometriosis and polycystic ovary it becomes more difficult to get pregnant, with “common” cysts, provided they are not malignant, the situation is different. During the ultrasound, when the gynecologist discovers that the woman is pregnant and also has cysts, the attitude should be that of continuous monitoring throughout the nine months of gestation.
Generally, if the size of the cysts is contained, they will tend to reabsorb on their own, without causing particular problems. However, in some cases, the future mother might experience swelling and severe pain, as this fluid formation will tend to increase in volume in the following gestational months. In very rare cases instead, which worry the gynecologist more, it is possible that the cyst might rupture, releasing the fluid that was present in the sac. In this scenario, the woman will experience severe pain, but generally, there should be no complications for the child, as even in this case, the fluid will tend to reabsorb on its own.
When should a specialist intervene surgically?
Once the gynecologist has ascertained that the pregnant woman has one or more ovarian cysts, what they will do is monitor the evolution of the situation month by month. Generally, there should be no problems, in case of severe pain, the woman will have to take particular medications that will not affect the health of the child and will need to remain at preventive rest. In three very serious cases, the specialist may decide to intervene surgically:
- If there is a serious risk of infection after the cyst rupture.
- Ovarian torsion when the blood flow is blocked.
- When it compromises the correct course of gestation and poses dangers to the fetus, for example, very large dimensions.
In these three cases, the gynecologist will have to decide, obviously case by case also based on the clinical situation of mother and child, whether or not to intervene surgically. Based on the dimensions, they will have to decide whether to proceed with laparoscopy or with classic abdominal surgery. Precisely due to the high risk of a miscarriage, they try to get at least past the sixteenth week and never beyond the twenty-eighth week.
In conclusion, it is fortunately quite rare that simple ovarian cysts can affect a woman’s fertility, as many pregnant women exhibit this phenomenon. Cysts can affect much more the correct state of gestation itself. In the vast majority of cases, however, these cysts will reabsorb on their own by the second semester. Obviously, in the presence of these, it is advisable during pregnancy to also refer to specific centers that deal precisely with the monitoring of cysts in pregnancy.