How are ovarian cysts, surgery and infertility related?

This paper studied the relationship between ovarian cysts, surgery and infertility.

An ovarian cyst is a fluid filled sac found in the ovary. It is difficult to determine the impact of ovarian cysts on infertility and on assisted reproductive technology. Potential complications from ovarian cysts can be managed through surgery. However, it is also not well known how surgery can affect infertility. 

The authors evaluated results from various studies.

Several studies evaluated the impact of surgery for endometrioma (a non-harmful, estrogen-dependent cyst found in the ovary of women of reproductive age) on fertility. A study found that the antimüllerian hormone level decreased by 30% after surgery. Antimüllarian hormone is used to determine the quantity of eggs remaining in a woman’s ovaries with lower levels indicating fewer eggs. The decrease of antimüllerian hormone was greater in women with endometriomas in both ovaries compared to one ovary.

Other studies looked at the impact of surgery for non-endometriotic cysts. A study found that after removal of cysts, the ovarian reserve (a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization) decreased by 40%. The number of follicles (each containing a single egg) also decreased.   

Additionally, studies looked at how surgical treatment impacted assisted reproductive treatments. It was found that surgery for endometrioma did not seem to improve pregnancy rates.

However, surgery is necessary in certain situations. A laparoscopic cystectomy (minimally-invasive removal of cyst) is the preferred method. For example, the risk of recurrence was 84% in those receiving aspiration (draining of fluid from the cyst) compared to 4% in those recieving laparoscopic cystectomy.

Ablation (energy is used to destroy cells) can also be used. However, a study found that patients who had their cysts surgically removed had 5.21 times the likelihood of spontaneous pregnancies compared to those receiving ablation. However, there was insufficient evidence to recommend surgical removal rather than ablation in assisted reproductive technologies.

Carbon dioxide laser vaporisation (using energy to remove a cyst) was compared with surgical removal. It was found that pregnancy rates were similar between both groups. Plasma energy vaporization (using energy to remove a cyst) was also compared to surgical removal, and was found to have less of an impact on the ovarian reserve. 

The authors concluded that management of ovarian cysts is complex and not clear-cut. Surgery could be more harmful to the ovarian reserve than the cysts itself. 

There was limited research results available for certain topics.