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‘Cyst’ is a condition found in women of all ages and can occur in various locations, not limited to any single organ. Dr. Teerayut Jongwutiwes, a gynecologist specializing in reproductive medicine with experience in obstetrics, gynecology, and reproductive medicine, explained about ovarian cysts and provided advice for women planning to conceive, as ovarian cysts may affect future pregnancy.
<h2>What is an ‘Ovarian Cyst’? 
</h2>
Cyst is a fluid-filled sac that forms in the human body. Therefore, an ovarian cyst is a fluid-filled sac that forms inside the ovary and has a growth mechanism that may affect the body. It can be divided into 2 types: pathological cysts and natural cysts that can resolve on their own.
<ul>
<li>Pathological cysts are abnormal fluid-filled sacs that can cause disease within the organ where the cyst is found. They can be divided into 2 types: common pathological cysts such as chocolate cysts, and cysts caused by cancer.</li>
<li>Natural cysts that can resolve on their own Normally, the ovary produces one follicle per cycle that ovulates. Natural cysts may occur when the follicle grows normally but fails to ovulate, resulting in a cyst or fluid sac remaining inside the ovary. These cysts are absorbed by the body and disappear within 3 months. Additionally, normal ovulation can also cause cysts if bleeding occurs inside the follicle after ovulation, forming a blood clot that the body will absorb and resolve on its own.</li>
</ul>
When a cyst is first detected, doctors cannot immediately determine the type of cyst unless it shows specific symptoms of a particular disease. Usually, observation and follow-up for about 2-3 months are required. If the cyst does not resolve naturally, it is then considered pathological.
<h2>What Symptoms Indicate an ‘Ovarian Cyst’? 
</h2>
Cysts are considered a silent threat to women’s health because they usually do not show symptoms, whether they are natural cysts, pathological cysts, or even ovarian cancer cysts. This makes it difficult for patients to realize they have a cyst or know when it might occur or how to prevent it.
However, some cyst types do show symptoms, such as chocolate cysts, where patients experience chronic lower abdominal pain or menstrual pain. The pain does not depend on the cyst size but on the location of the lesion causing the pain. Therefore, anyone with these symptoms regularly should get a medical examination to find the cause. If a cyst is detected, a treatment plan can be made.
Most ‘cysts’ are found incidentally during examinations for other conditions. One common symptom is infertility, where patients come to see a doctor due to difficulty conceiving, and cysts are found to be an obstacle.
<h2>How Do ‘Ovarian Cysts’ Affect Pregnancy? 
</h2>
Cysts that cause pregnancy problems are usually pathological cysts, such as chocolate cysts or endometriosis, which affect ovarian function and make it harder for patients to conceive. They can be divided into 2 types based on the location of the disease as follows:
<ul>
<li>Endometriosis occurring in the ovary causes cysts. When these cysts are small, follicles can develop normally, but the quality of the follicles in an environment with chocolate cysts contains certain chemicals that reduce the quality and growth of the follicles compared to the ovary without cysts. As the cyst grows larger, follicle development becomes more difficult. For example, a 1 cm cyst leaves enough space in the ovary for follicles to grow normally, but a 5 cm cyst reduces the space, increasing ovarian pressure and possibly preventing ovulation on the affected side. When ovulation does not occur on the cyst side, the chance of pregnancy decreases.</li>
<li>Endometriosis occurring outside the ovary can cause lesions in other organs within the abdominal cavity or uterus. This may lead to adhesions at the fallopian tubes, causing blockage, which is a major cause of infertility as eggs and sperm cannot meet. Additionally, if endometriosis invades the uterine muscle layer, it causes the uterus to enlarge, become misshapen, or abnormal, making embryo implantation more difficult. When the embryo cannot implant in the uterine wall, the chance of pregnancy decreases.</li>
</ul>
Therefore, whether cysts occur inside or outside the ovary, they can affect pregnancy because the female reproductive system diseases are interconnected.
<h2>Treatment When Chocolate Cysts Are Detected 
</h2>
There are generally 2 treatment methods: medication and surgery.
<ul>
<li>Medication: All medications used to treat ovarian cysts are contraceptive drugs, which prevent pregnancy because the disease depends on female hormones produced by the ovary each month to grow. Treatment requires medication to inhibit follicle growth to calm the disease, so this method is not suitable for those who want to conceive.</li>
<li>Surgery: This can be done by laparoscopic surgery to remove the cyst. The benefit of laparoscopy is that it allows diagnosis to determine whether the cyst is benign or cancerous and to treat the cyst precisely. If other lesions are found during laparoscopy, they can be destroyed, making the uterus, ovaries, and surrounding organs disease-free for a period and improving natural fertility. If fallopian tube blockage is detected, treatment or surgery can be planned to prepare for future conception. This surgery has a quick recovery and small incisions.</li>
</ul>
However, surgery has side effects and risks that patients must consider, such as anesthesia and the risk of damaging internal organs due to adhesions caused by endometriosis. Another caution affecting fertility is that removing the cyst may also remove healthy ovarian tissue attached to the cyst wall. Losing part of the ovarian wall can reduce ovarian function, follicle quantity, and follicle growth. Small cysts may be easily removed without much impact, but large cysts requiring extensive tissue removal may reduce or eliminate the ovary’s ability to produce eggs.
The appropriate treatment for each patient varies depending on the disease characteristics and treatment goals. Therefore, patients should consult with their doctor to discuss the pros and cons of each method and plan treatment together. If the patient wants to conceive, the doctor will find a way to clear the disease first and plan for future pregnancy.
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Dr. Teerayut Jongwutiwes 
Reproductive Medicine Specialist 
Infertility Treatment Center, Phyathai 2 Hospital

Cysts that cause pregnancy problems are often caused by pathological cysts, such as chocolate cysts or endometriosis, which usually affect the functioning mechanism of the ovaries and make it more difficult for patients to conceive.

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Ovarian cysts... the risk of infertility that should not be overlooked

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