One of the most frustrating experiences for some women preparing to go through IVF is to find an ovarian cyst at their baseline ultrasound. An ovarian cyst can produce hormones that inhibit the ability of other follicles to develop and even reduce their potential by their size alone. Worse still, in rare instances they can grow and become a surgical emergency. For these reasons, most fertility specialists prescribe a birth control pill (to inhibit further growth) and cycle delay in order to let the ovaries return to a resting state before starting the ovarian stimulation process. However, this is not the only option.
Ovarian cyst aspiration is a procedure that I have been performing for over a decade. And yet, I’ve long been amazed that my colleagues don’t offer this simple procedure to their patients. Many cite the “lack of data” as the reason that they never started draining cysts. I had to go to a prominent cardiology journal to find a well designed study on ovarian cyst drainage back in 2006—the results were very encouraging. Since that time several studies were performed and their data was collectively summarized in a Cochrane review published in 2014. Ironically, their conclusion is that cyst drainage did not improve the pregnancy rate over cycle cancellation. But it is also noteworthy, that draining the cyst prior to proceeding did not reduce the chance of pregnancy, did not reduce the number of eggs collected in the IVF cycle, nor did the procedure create an increase in complications or cycle cancellations.
Here at Conceptions, I’ve done a small study on the last 60 cyst drainage cases—all performed within the last year and a half. The patients rated the discomfort of the procedure as about a two out of ten (range 0 to 4). We have not experienced any complications of bleeding, infection or cycle cancellation. Most notably, all of the patients felt that the option of having their cyst drained instead of simply delaying their cycle was a very positive experience.
Conclusion: cyst drainage prior to IVF is a safe and reasonable alternative to delay-and-pray approach.
~Dr. Robert Greene