Ovarian Cysts and Achieving Pregnancy with Endometriosis
While many women and their doctors fear that achieving pregnancy will be difficult for the woman with endometriosis, I am here to tell you that this is not necessarily the case.
Let me follow that up with this statement: as with most things medical, each woman’s experience of trying to get pregnant with endometriosis will be different. For some, it will happen without drama or difficulty, while others may experience significant challenges in achieving a pregnancy.
Before we go on to explain how endometriosis can affect the ability to conceive, let’s clarify the term “ovarian cyst.”
Functional vs. non-functional cysts
Each month, as part of a woman’s normal cycle, a fluid-filled cyst, called a follicle, develops on the ovary. This is where the egg develops. The follicle also produces estrogen, the first female hormone to be released during the first part of the menstrual cycle.
At the time of ovulation, a mature follicle can grow to as large as 2.5 cm in diameter.
Once the follicle releases the egg (the process known as ovulation), the follicle bleeds into itself and creates a second cyst, known as the corpus luteum. The corpus luteum produces progesterone, the second female hormone.
The follicle and the corpus luteum are known as functional cysts, since obviously they play a role in the monthly cycle and in achieving a pregnancy.
These functional cysts are not to be confused with cysts that are not related to the normal function of the menstrual cycle. Endometriomas are one example of these non-functional cysts.
Endometriomas are growths composed of endometrial cells that have grown outside the uterus and, in this case, have attached themselves to the ovaries.
Endometriomas and getting pregnant
Let’s start by saying again that getting pregnant with a diagnosis of endometriosis is different for every woman.
When a woman with endometriosis has difficulty conceiving, it is often not simply a structural or physical problem. For example, the problem is not always as simple as an endometrial growth that is standing in the way of an egg being released.
Let’s not forget that there is still a lot about endometriosis that we don’t understand. There are chemical factors that can impair the fertility process that are not completely clear.
It’s likely that many women are successful at conceiving who in fact have endometriosis on the ovary and have not been diagnosed. What this means, of course, is that it’s entirely possible to become pregnant with this diagnosis.
When surgery can help
On the other hand, if an endometrioma on an ovary is known to exist, and pregnancy has not been achieved after 12 months, surgery is an option to be considered.
As is the case in endometriosis of other organs, simply draining a cyst will not achieve much, since the cyst will return and invade more deeply into the ovary, risking the loss of ovarian function. Only by excising the cyst itself can ovarian function and fertility be preserved.
When an ovarian endometrioma is removed, there is always some adjacent ovarian tissue that is removed along with it. Many people understandably fear that this process will actually harm the ovaries.
Ovaries can often function better with the endometriosis removed, but sometimes the ovaries can stop functioning, temporarily or permanently, after removal of disease, depending on how much viable ovarian tissue is still present after removal of the disease.
There is no guarantee that a person will ever have a successful pregnancy, but if endometriosis is allowed to persist in the ovary, then over time, the ovary will eventually be destroyed. The endometriosis needs to be removed to save ovarian function and preserve fertility.
There is no more effective step you can take to encourage conception than complete removal of endometriosis and its associated fibrosis with restoration of normal anatomy.