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Ovarian cyst

"Ovarian cyst as applied to issues of the reproductive medicine”

Interview with Yurii Gerevich, an obstetrician-gynaecologist, reproductive endocrinologist, Candidate of Medical Sciences.

What is the danger of a cyst in women?

Cysts in women are dangerous because sometimes they can cause serious illnesses. First of all, oncological diseases. Ovarian cysts can be cancer, and, of course, it is dangerous. Additionally, the fact is that ovarian cysts can be precancerous conditions. That is, an oncological disease may develop in this cyst after some time. Naturally and obviously, it is also very alarming. It is best to know about this as early as possible to prevent this serious illness. In general, there are many different types of cysts. The next category, for example, endometrioid cysts. They are dangerous in that they worsen the quality of life, cause pain, and can lead to a decrease in fertility. That is, to the development of infertility in some women. There are also congenital, the so-called dermoid cysts, which are the result of violations of the initiation of organs in the prenatal period, and those tissues that should not be there appeared in the ovary. Most often, this is fatty tissue, hair follicle tissue, tooth tissue and so on. These cysts grow slowly with age and can also cause pain over time, can sometimes become malignant, and disrupt the quality of life. Well, the most common cysts are the so-called functional cysts that temporarily appear and then disappear on their own. They can be harmful if we talk about reproductive medicine. They can also be the cause of pain syndrome, cause rupture of ovarian cyst, which can lead to bleeding, to surgical intervention in urgent order. Therefore, cysts can lead to a lot of troubles.

Why is it necessary to remove a cyst before a puncture?

So why is it necessary to remove the cysts? We have just discussed what dangers a cyst has. If God forbid, there is cancer, it is evident, it is necessary to treat. Of course, even if the precancerous condition, it must be solved before the beginning of reproductive technologies - before the puncture. If they result in pregnancy, we will not be able to intervene for a long time. It can lead to sad consequences, especially since oncological, pre-oncological processes, as a rule, accelerate their development during pregnancy. Also, if we are talking about an endometrioid cyst, this is a complex, debatable question. But still, if it is possible to remove the cyst without disturbing, without significantly reducing the real reserve, if the real reserve is good enough initially, then, in principle, yes, it makes sense to remove the cyst, reduce the negative effect of the endometrioid cyst. It is a chronic inflammation that affects all the links that are important for pregnancy, and this operation will also be useful and will improve the results of reproductive technologies. For example, a woman has a low initial ovarian reserve. There were operations or endometriosis has developed for a long time.  The development of endometriosis and endometrioid cysts leads to a decrease in the ovarian reserve. In such a case, for example, I would recommend to make stimulation first, get the eggs, freeze the embryos, and only then to carry out an operation and get ready for the transfer. That is, to make such a segmented treatment cycle. Because, if we are going for surgery, we need to be aware that after all, we will reduce the ovarian reserve by removing this endometrioid cyst. If we are talking about functional cysts, then they can interfere purely mechanically at the beginning of stimulation. That is, the ovary is exaggerated due to the cyst.  There is an increased risk of complications during stimulation: the rupture of the ovary or the ovarian torsion. Therefore, it is better to get rid of such a cyst before stimulation. If this cyst is hormonally active during this period, then, of course, it will interfere with the stimulation and adequate growth of follicles. In general, it is believed that stimulation should be started when there are no cyst formations in the ovaries more than 9 mm in diameter.

Does the cyst affect the quality of the follicles?

If we are speaking about the endometrioid cysts, then yes. The conducted researches established that with endometriosis, the quality and the number of cells obtained, deteriorate. In all other cases, there is no such direct connection. But if we start stimulation on the background of a hormone-active functional cyst, our stimulation may not be very successful. We can get fewer and worse cell quality than we could get from the same woman in the absence of a cyst.

What leads to the formation of cysts?

It is a difficult question since there are a lot of varieties of cysts. If we are talking about endometriomas, they develop as a result of a condition in which uterine endometrial cells grow outside the uterus. Some of the tissue attaches to the ovary and form a growth.  If we are talking about teratodermoid cysts, as I already said which are the result of violations of the initiation of organs in the prenatal period, and those tissues that should not be there appeared in the ovary. If we are talking about a large number of varieties of other cysts, it is a violation of the processes in the epithelium. It is known that a cyst is a cavity. The inner surface of the cyst is lined with epithelial tissue. The epithelial tissue is a rapidly dividing tissue.  In these tissues, certain violations of the development of the division of these cells, their specialization, often occur. These processes, being violated, can lead to various disorders, to the development of permanent cysts, and not temporary ones, to the development of precancerous and cancerous diseases. Therefore, the reasons are complex: it is a genetic predisposition, impaired immunity, possibly the impact of the external environment. Until the end, no one will tell you for sure.

How to treat a cyst?

Cysts are treated, and if we are talking about permanent cysts, then the only way is the surgical method. If we are talking about functional cysts, then they must go away on their own. You can contribute to this, create favourable conditions with the help of medical support, the use of oral contraceptives to stop the process of development and growth of dominant follicle choices. It is also believed, that the addition of the progesterone drugs, results in some changes of the blood vessels of the walls of the cysts, and it leads to their opening. And so, the cyst can go away. But of course, the only treatment is a surgical operation. 

Is there a link between ovarian cysts and infertility?

If we are talking about endometrioid cysts, I have already said, that endometriosis is associated with decreased fertility. For other cysts, there is no direct connection. But cysts can lead to disorders that force one to go for a surgical treatment.  For example, if a woman has ovarian torsion, she can lose the ovary as a result of the operation.  Other operations that are performed in the presence of cysts also reduce ovarian reserve and affect fertility. So endometrioid cysts directly affect, the rest can consistently have a negative effect. 

What recommendations can you give to our clients? Is it necessary to go to the clinic right away? Can one go to the pharmacy and buy some medicine and treat it like that?

Of course, it's necessary to be careful with cysts. First of all, you and your doctor should decide which cyst is in question: permanent or functional? What kind of cyst? What is its danger in terms of potential oncological threat? Therefore, in order not to have problems with this, you need to consult a doctor regularly. If you got a particular cyst, then you need to watch it, or until it leaves and it will be clear that it is a functional cyst or to determine that it is a constant one. You should establish then what kind of cyst you have. Although, only a histological examination will give the final answer, of course. But having established, that it is a constant cyst, having made with high accuracy the assumptions to which class the cyst belongs to, further, depending on the individual characteristics of the woman, one can already choose a tactic.