Can Ovarian Cysts Cause Infertility? What New Research Actually Shows
- 2 days ago
- 11 min read
Here is the direct answer: most ovarian cysts will not affect your fertility, but a few specific types absolutely can — and the wrong surgery at the wrong time can cost you eggs you'll never get back. A 2022 systematic review of 36 studies found that surgery to remove endometriomas — the cyst type most often linked to infertility — significantly lowers ovarian reserve in the short, medium, and long term (Younis et al., Frontiers in Endocrinology, 2022).
At the same time, the 2023 international PCOS guideline confirms that polycystic ovaries — a different condition entirely — remain one of the most treatable causes of infertility worldwide (Teede et al., Human Reproduction, 2023). The cyst on your ultrasound is one data point. What it actually means depends on which type you have, how big it is, and what you do next. The rest of this post explains exactly what the evidence shows and what to do with it.
Table of Contents
What Ovarian Cysts Actually Are — and Why Most Don't Hurt Fertility
An ovarian cyst is a fluid-filled sac that forms in or on an ovary. They are one of the most common findings in reproductive-age women — about 7% of women worldwide develop a cyst at some point, and roughly 1 in 5 women will develop a pelvic mass in their lifetime (Mobeen and Apostol, StatPearls, 2023). In premenopausal women, almost all of them are benign. The chance of a symptomatic cyst being malignant is approximately 1 in 1,000 (RCOG Green-top Guideline No. 62, 2011).
The reason most cysts have nothing to do with fertility is that most cysts are part of how a healthy ovary works. Every month, your ovary recruits a follicle, grows it, and releases the egg. If the follicle doesn't rupture and keeps growing, that's a follicular cyst. If it ruptures normally and then reseals, that's a corpus luteum cyst. Both are byproducts of normal ovulation. Both resolve on their own within a few weeks (American College of Obstetricians and Gynecologists, Ovarian Cysts FAQ, 2023).
The American College of Obstetricians and Gynecologists explicitly recommends that simple cysts can be safely monitored without intervention, even in postmenopausal women, because they rarely become anything dangerous (Mimoun et al., Clinical and Experimental Obstetrics & Gynecology, 2014). When your doctor says "we'll watch it" — that is not negligence. It is the evidence-based standard.
The cyst types that don't affect fertility:
Follicular cysts — form when an unreleased follicle keeps growing. Resolve within 1–3 cycles.
Corpus luteum cysts — form after ovulation. Resolve on their own within weeks.
Small dermoid cysts — benign growths that contain different tissue types. A 2024 review of over 1,000 dermoid cases found malignant transformation rates of only 1.1%, and most can be managed laparoscopically with low complication rates if removal becomes necessary (Foley et al., American Journal of Obstetrics & Gynecology, 2024).
Simple cystadenomas under 5 cm — fluid-filled benign tumors that usually don't interfere with ovulation.
The Three Cyst Types That Can Affect Fertility
Three categories of ovarian cysts can genuinely affect a woman's ability to conceive. Each one works through a different mechanism, and each one requires a different clinical approach.
Endometriomas — The Cyst Type Most Linked to Infertility
Endometriomas are cysts caused by endometriosis — the same tissue that lines the uterus growing where it doesn't belong. Inside the ovary, that misplaced tissue bleeds month after month, eventually forming a dark, blood-filled cyst sometimes called a "chocolate cyst." Endometriomas are found in up to 20% of women with endometriosis, and endometriosis itself affects roughly 10% of reproductive-age women globally (Younis et al., Frontiers in Endocrinology, 2022).
The fertility impact comes through several pathways: chronic pelvic inflammation, scarring of the fallopian tubes, distorted pelvic anatomy, and direct damage to the ovarian tissue surrounding the cyst. But here is what most articles miss — removing an endometrioma surgically can hurt fertility too. We'll get into that research below.
Polycystic Ovaries (PCOS)
This one is named confusingly. The "cysts" in polycystic ovary syndrome are not actually cysts in the traditional sense. They are small immature follicles — eggs that never matured or ovulated — sitting along the edge of the ovary in a "string of pearls" pattern on ultrasound. PCOS is a hormonal and metabolic condition, not a structural one. It affects between 10% and 13% of reproductive-age women globally (Teede et al., Human Reproduction, 2023).
PCOS is the leading cause of anovulatory infertility worldwide. The good news: it is also one of the most treatable. The 2023 international evidence-based PCOS guideline — issued jointly by ASRM, ESHRE, and the Endocrine Society — recommends letrozole as first-line ovulation induction, with metformin and clomiphene as alternatives (Teede et al., Journal of Clinical Endocrinology & Metabolism, 2023). Many women conceive within a few cycles.
Large or Complex Cysts
Cysts larger than 5–6 cm, or cysts with solid components on ultrasound, can mechanically interfere with ovulation, distort fallopian tube anatomy, or rarely cause ovarian torsion (the ovary twisting on itself, cutting off blood supply). These usually need closer evaluation — often an MRI, sometimes a CA-125 blood test, and sometimes surgical assessment. Complex does not mean cancerous, and removal does not automatically mean infertility.
What the Research Shows — Cysts, Surgery, and Pregnancy Outcomes
Multiple meta-analyses now show that the relationship between ovarian cysts and fertility is more nuanced than "cyst = problem." For endometriomas in particular, the question is not just whether they affect fertility but whether the standard treatment — surgical removal — does more harm than good.
Endometrioma Surgery and Ovarian Reserve
A 2012 meta-analysis pooling data from 237 patients found a statistically significant drop in serum AMH (a marker of egg supply) after laparoscopic removal of endometriomas, with a weighted mean difference of −1.13 ng/mL (Raffi et al., Journal of Clinical Endocrinology & Metabolism, 2012). A larger 2022 systematic review of 36 studies confirmed that AMH drops persist in the short, medium, and long term after surgery — and that bilateral endometriomas and cysts larger than 7 cm cause the greatest decreases in ovarian reserve (Younis et al., Frontiers in Endocrinology, 2022). A 2024 critical appraisal of nine systematic reviews found moderate-to-high quality evidence that this damage can persist 9–18 months post-surgery (Younis et al., Frontiers in Endocrinology, 2024).
Comparison: Cyst Types and Fertility Impact
Cyst Type | Mechanism / Cause | Fertility Impact | Standard Approach |
Functional (follicular, corpus luteum) | Normal byproduct of ovulation | None — resolves on its own | Watchful monitoring; resolves in 1–3 cycles (ACOG, 2023) |
Dermoid (mature teratoma) | Benign growth from totipotent cells | Minimal unless large or causes torsion | Laparoscopic removal if >5 cm or symptomatic; 1.1% malignancy rate (Foley et al., 2024) |
Endometrioma | Endometrial tissue inside ovary | Significant — both cyst and surgery affect ovarian reserve | Individualized: IVF often preferred over surgery in fertility patients (Younis et al., 2022) |
PCOS-pattern follicles | Hormonal/metabolic; immature follicles | Causes anovulatory infertility — but highly treatable | Letrozole first-line; metformin, clomiphene; PRP rejuvenation (Teede et al., 2023) |
Large/complex cyst | Variable — fluid + solid components | Possible mechanical interference with ovulation | MRI evaluation; CA-125; surgical assessment if indicated |
Pregnancy Outcomes With Dermoid and Other Benign Cysts
One of the largest analyses of pregnancy outcomes in women with benign ovarian cysts found that the majority of cases were dermoid (36.7%) or cystadenomas (41.9%), most diagnosed during cesarean delivery rather than causing problems during pregnancy. Ovarian torsion occurred in only 3.2% of cases, and the overall course of pregnancy was favorable when the cysts were managed conservatively with ultrasound follow-up (Bromiker et al., Acta Obstetricia et Gynecologica Scandinavica, 2009).
The Question Nobody Else Answers — Should You Remove an Endometrioma If You Want to Get Pregnant?
This is the question every other clinic article skips, and it is the one that matters most if you are actually trying to conceive.
What you cannot get back: Once ovarian reserve is lost, it does not regrow. Eggs are not replaced. Every meta-analysis published in the last decade — Raffi 2012, Younis 2022, Younis 2024 — confirms that surgical excision of endometriomas reduces AMH levels, and that the reduction is greater when cysts are bilateral or larger than 7 cm (Younis et al., Frontiers in Endocrinology, 2022). The mechanical resection of healthy ovarian tissue, plus inflammatory damage to the ovarian cortex, is the proposed mechanism.
What that means clinically: If you have an endometrioma and you want to conceive, surgery should not be the default first step. For many patients — especially those with diminished ovarian reserve, women over 35, or anyone planning IVF — proceeding directly to assisted reproduction without removing the cyst preserves more eggs and produces better outcomes. The cyst is monitored. The eggs are protected. The treatment goes forward.
Surgery still has a role: severe pain, suspected malignancy, very large cysts that block egg retrieval, or cysts causing significant symptoms. But the decision should be made with a reproductive endocrinologist in the room — not by a general gynecologist working alone. The cost of that conversation is one consultation. The cost of the wrong call is permanent.
At Rejuvenating Fertility Center, we routinely review cyst surgery recommendations from outside providers. Some go forward. Many don't. The reproductive picture has to come first.
PCOS vs. Ovarian Cysts — Why They're Not the Same Thing
The single most common confusion we see in the clinic: a patient is told "you have cysts on your ovaries" and assumes she has PCOS, or vice versa. They are fundamentally different conditions.
An ovarian cyst is a single (or sometimes a few) fluid-filled sacs. It is a structural finding. The fertility impact depends entirely on which type.
PCOS is a hormonal and metabolic syndrome. The "polycystic" pattern is multiple small immature follicles — usually 12 or more per ovary on ultrasound — caused by anovulation. PCOS is diagnosed using the Rotterdam criteria, which require at least two of: irregular cycles, clinical or biochemical hyperandrogenism (high testosterone, acne, excess hair growth), or polycystic ovaries on ultrasound (Teede et al., Human Reproduction, 2023).
You can have a single ovarian cyst without having PCOS. You can have PCOS without ever having a "cyst" in the traditional sense. The treatment is completely different:
Single cyst: monitor, evaluate type, treat the underlying issue if applicable.
PCOS: address ovulation directly with letrozole or metformin; address insulin resistance; treat hyperandrogenism; consider PRP Ovarian Rejuvenation for non-hormonal options.
This is where RFC's research history matters. Dr. Zaher Merhi published the first report on the benefits of PRP ovarian rejuvenation for PCOS symptoms — for patients who want a non-hormonal approach to restoring ovulatory function. The mechanism involves growth factors stimulating dormant follicles and improving the ovarian environment, rather than overriding hormonal pathways with medication.
What to Do If You Have an Ovarian Cyst and Want to Conceive
Step 1: Get the right diagnosis. Not all cysts are equal, and the imaging report needs to specify type. Request a transvaginal ultrasound and ask for the cyst characterization: simple vs. complex, size, unilateral or bilateral, and whether the appearance suggests endometrioma (the classic "ground glass" pattern), dermoid (mixed echogenicity), or functional (clear fluid). If the report is unclear, an MRI gives sharper detail.
Step 2: Get fertility-specific bloodwork before any surgery is scheduled. Request these from your OB-GYN or reproductive endocrinologist: AMH (anti-Müllerian hormone), Day 3 FSH and estradiol, antral follicle count via ultrasound, ferritin and Vitamin D level. AMH and AFC together tell you what you have to work with. If your reserve is already low, surgery becomes a much harder decision.
Step 3: Ask your RE these questions. "What type of cyst is this — and how confident are you?" "Based on my AMH and AFC, what is my estimated ovarian reserve right now?" "If we remove this cyst surgically, what is the expected impact on my AMH?" "Can we proceed to IVF without removing this cyst?" "What is your clinic's experience with patients my age who have this cyst type?"
Step 4: Match the treatment to the cyst type. Functional cyst — wait one to three cycles, repeat ultrasound. Dermoid under 5 cm — monitor unless symptomatic. Endometrioma + trying to conceive — strongly consider IVF before surgery, especially with low reserve. PCOS — letrozole first-line per the 2023 guideline, with PRP ovarian rejuvenation as a non-hormonal option. Large or complex cyst — full evaluation including MRI and tumor markers.
Step 5: Don't lose time waiting. If you are over 35 and have been trying for six months, or over 40 and have been trying for any length of time, the cyst is one variable in a larger fertility picture that needs evaluation. RFC has no age or weight cutoffs, and same-day consultation appointments are available across our New York and Connecticut locations.
Frequently Asked Questions
Can ovarian cysts cause infertility on their own?
Most cannot. Functional cysts, small dermoids, and small simple cystadenomas typically don't affect fertility at all. The cyst types that genuinely cause infertility are endometriomas (through inflammation and scarring) and PCOS-pattern ovaries (through anovulation). Even within those categories, treatment is available — and many women conceive successfully with the right approach (Teede et al., Human Reproduction, 2023).
Should I have an ovarian cyst removed before trying to get pregnant?
Not without a fertility consultation first. Surgical removal of endometriomas has been shown across multiple meta-analyses to significantly reduce ovarian reserve as measured by AMH, with effects lasting 9–18 months or longer (Younis et al., Frontiers in Endocrinology, 2022). For functional cysts, watchful monitoring is the standard. For dermoids, the decision depends on size and symptoms. The right choice depends on cyst type, your ovarian reserve, your age, and your reproductive timeline — not a one-size rule.
Can I get pregnant with PCOS?
Yes. PCOS is the leading cause of anovulatory infertility but is also one of the most treatable. The 2023 international PCOS guideline recommends letrozole as first-line treatment for ovulation induction, with strong success rates across multiple cycles (Teede et al., Journal of Clinical Endocrinology & Metabolism, 2023). For patients who prefer to avoid hormonal medications, RFC also offers PRP Ovarian Rejuvenation — based on Dr. Merhi's published research on PRP for PCOS.
How are ovarian cysts diagnosed?
Transvaginal ultrasound is the primary diagnostic tool and can usually distinguish simple cysts from complex cysts and endometriomas. MRI is added when the imaging is ambiguous. CA-125 is sometimes used but is not a reliable screen on its own — it can be elevated in benign conditions including endometriosis itself (Mimoun et al., Clinical and Experimental Obstetrics & Gynecology, 2014). For fertility patients, additional testing includes AMH, antral follicle count, day-3 FSH, and tubal patency assessment.
Will an ovarian cyst go away on its own?
Functional cysts almost always do — typically within one to three menstrual cycles (American College of Obstetricians and Gynecologists, 2023). Endometriomas, dermoids, and complex cysts generally do not resolve spontaneously and require monitoring or treatment. The first step is identifying which type you have.
Can ovarian cysts come back after surgery?
Endometriomas have notable recurrence rates after surgery, particularly in the absence of pregnancy or ongoing hormonal suppression. This is one of the strongest arguments against rushing to surgery in fertility patients — you may sacrifice ovarian reserve and still face cyst recurrence, ending up with fewer eggs and the same diagnosis. Functional cysts can also recur, especially in patients with hormonal patterns that favor anovulation.
The Bottom Line
An ovarian cyst on your scan is not a sentence. Most cysts have nothing to do with fertility, the cysts that do are usually treatable, and the wrong surgery at the wrong time can do more damage than the cyst itself. The right approach is to identify the cyst type, run the right fertility bloodwork, and make decisions with a reproductive endocrinologist in the room — not after a surgery has already lowered your egg supply.
If you have an ovarian cyst and you're thinking about your fertility — whether you're trying now, planning to soon, or want to preserve your options — schedule a consultation with the team at Rejuvenating Fertility Center. Bring your imaging. We'll review it with you, run the bloodwork that matters, and walk through every option before you make a decision you can't take back.
Article Sources
Mobeen S, Apostol R. Ovarian Cyst. StatPearls Publishing, 2023.
Royal College of Obstetricians and Gynaecologists. Management of Suspected Ovarian Masses in Premenopausal Women. Green-top Guideline No. 62, 2011.
American College of Obstetricians and Gynecologists. Ovarian Cysts. ACOG Patient FAQ, 2023.
Mimoun C, Fritel X, Fauconnier A, et al. Current diagnosis and management of ovarian cysts. Clinical and Experimental Obstetrics & Gynecology, 2014.
Foley OW, et al. Dermoid cyst management and outcomes: a review of over 1000 cases at a single institution. American Journal of Obstetrics & Gynecology, 2024.
Younis JS, Shapso N, Fleming R, et al. The Effect of Laparoscopic Endometrioma Surgery on Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 2022.
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism, 2012;97(9):3146-54.
Younis JS, Shapso N, Ben-Sira Y, et al. The impact of ovarian endometrioma and endometriotic cystectomy on anti-Müllerian hormone, and antral follicle count: a contemporary critical appraisal of systematic reviews. Frontiers in Endocrinology, 2024.
Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction, 2023;38(9):1655-1679.
Teede HJ, et al. 2023 International Evidence-based Guideline for the Assessment and Management of PCOS. Journal of Clinical Endocrinology & Metabolism, 2023;108(10):2447-2469.