Ovar­ian cysts are very com­mon dur­ing repro­duc­tive age women. The cyst has a wall and is full of fluid. Very few of ovar­ian cysts are can­cer after puberty and before menopause. The two most com­mon types are fol­lic­u­lar cysts and cor­pus luteum cysts. These are the result of fol­li­cle growth in the ovary (the sac that con­tains the egg) that either a. does not release the egg and con­tinue to grow or b. releases the egg then the fol­li­cle wall now called the cor­pus luteum closes and reform a cyst. The vast major­ity of these cysts require just obser­va­tion as they resolve on their own.

The other two com­mon benign cysts are der­moid cysts and endometri­omas. Der­moid cyst is a devel­op­men­tal cyst that are com­monly found in young women. It is very rare for them to become can­cer. Larger cysts can twist and become painful as they twist the blood ves­sels of the ovary. This needs prompt med­ical atten­tion. Endometri­omas are benign cysts full of old blood. The wall of endometri­oms is sim­i­lar to the lin­ing of the uterus-endometrium. They some­times cause pelvic pain.

Benign tumors of the ovary can also include serous or muci­nous cysts, they con­tain thin or thick fluid, respec­tively. They rarely become malig­nant. Border-line ovar­ian cysts exhibit more activ­ity of the cells lin­ing the cyst wall but lack the inva­sion seen in can­cer. Malig­nant cysts do exist but are not com­mon before the age of 40.

Eval­u­a­tion of ovar­ian cysts include clin­i­cal his­tory, pelvic exam, care­ful ultra­sound, color doppler to study blood flow into the cyst and blood work to assay tumor mark­ers. Vagi­nal ultra­sound, can in expert hands, delin­eate the char­ac­ter­is­tic appear­ance of the cyst and can reach an accu­rate diag­no­sis in 90% of der­moid cysts and endoemtri­oms. Some­times a fol­low up of six to eight weeks is needed as the major­ity of fol­lic­u­lar and cor­pus luteum cysts will dis­ap­pear dur­ing this period. Larger cysts that do not appear dur­ing that period may require sur­gi­cal eval­u­a­tion, usu­ally using min­i­mally acess surgery-laparoscopy.

Fer­til­ity preser­va­tion in women diag­nosed with ovar­ian cysts. The most impor­tant ini­tial task is to exclude malig­nancy in an ovar­ian cyst.                   Benign cysts- can be man­aged using obser­va­tion every 6 months or ovar­ian cys­tec­tomy. Ovar­ian cys­tec­tomy entails mak­ing a cut in the ovary and removal of the cyst and the cyst wall. Removal of the cyst wall, inad­ver­tently remove some of the adja­cent ovar­ian tis­sue. Some­times that impairs the future func­tion of the ovary and reduces ovar­ian reserve and pos­si­bly the chance of future preg­nancy. This is espe­cially true if the surgery has to be repeated in the future or needs to be done on both sides. If the type of cyst is known with high degree or cer­tainty as in the case of der­moid cysts and endometri­omas, the cysts are small and not caus­ing any com­plaints, young women can elect to observe them until they com­plete their fam­ily. If ovar­ian cys­tec­tomy is planned, dis­cus­sion of the effects on ovar­ian func­tion should be  ini­ti­ated as well as eval­u­a­tion of ovar­ian reserve before and after surgery. Ovar­ian stim­u­la­tion and egg or embryo freez­ing can be accom­plished prior to surgery. For some women, ovar­ian tis­sue freez­ing can also be per­formed at the time of surgery.

Bor­der­line ovar­ian cysts. Bor­der­line ovar­ian cysts can be treated with cystectomy-removal of the cyst, oophorectomy-removal of the whole ovary or hys­terec­tomy with removal of both ovaries. There is no evi­dence that one treat­ment is bet­ter than the other in terms of sur­vival. For women who desire future fer­til­ity removal of the cyst only is a viable option. If the ovary need to e removed, ovar­ian stim­u­la­tion, egg retrieval and embryo or egg freez­ing can be per­formed prior to surgery.

Malig­nant ovar­ian cysts. Malig­nant ovar­ian tumors lim­ited to one ovary, can be treated by removal of that ovary with preser­va­tion of the uterus and the other ovary. Unfor­tu­nately, those that spread beyond the ovary may require hys­terec­tomy and removal of both ovaries.

If you have an ovar­ian cyst and surgery was rec­om­mended, con­sul­ta­tion with a repro­duc­tive endocri­nol­o­gist and oncol­o­gist or gyne­col­o­gist can clar­ify pos­si­ble effects of surgery on future fer­til­ity. Women then will have the oppor­tu­nity to under­stand fer­til­ity preser­va­tion options avail­able for them.