When it comes to cysts, don’t call Dr. Google

In today’s internet age, patients can be their own best advocate or their worst enemy when researching medical terms, diagnoses and treatments.

A great example of this is in the word “cyst.” Many people come across the word “cyst” when they are searching the internet for information about infertility. The word “cyst” is a very generic term that means any fluid filled space in the body. Using the word cyst is like saying you drive a car. It doesn’t really tell you what kind of car you drive, how reliable it is, etc. The problem with the word is that it refers to all types of fluid filled spaces, which could be as serious as an ovarian cancer or a normal as a developing egg unit. So it is important to know what type of cyst is being described.

For infertility patients, there are usually only a few cysts that need defining. First, as an egg develops over the course of a cycle, the egg surrounds itself with fluid i.e. a cyst. This is a follicle, and it is normal and essential for reproduction. Sometimes, one of these follicles fails to release the egg and remains throughout the next cycle. This can happen after a Clomid treatment or sometimes in women with irregular cycles. These are harmless unless they break and bleed, but usually by waiting a month or using birth control pills for a month, they will go away on their own. Occasionally, in IVF cycles, the fluid can be removed vaginally by injecting a needle into the cyst and gently sucking it out.

Another type of cyst seen somewhat infrequently for fertility patients is a cyst that forms when there is endometriosis in the ovary. These are called an endometrioma or a chocolate cyst. These have a very distinctive appearance on an ultrasound and usually can be identified by a simple pelvic ultrasound.

Finally, some women have polycystic ovarian syndrome. Poly means many, so this is a situation where there are many cysts in the ovary. The ultrasound is used as one of the three criteria that are needed to make the diagnosis of PCOS. The cysts are small egg units (follicles) that have failed to grow and release the egg due to the increased levels of male hormone within the follicles. If there are 12 or more of these in one or both ovaries measuring 3-9 mm, it is termed a “polycystic ovary” by ultrasound.

A good takeaway from a ‘real’ physician (as opposed to Dr. Google) is that if a woman is told she has a cyst or many cysts, then the next logical step is to determine what type of cyst it is: a friendly normal egg unit or something more sinister?

Dr. John Rinehart maintains an exclusive practice in infertility and reproductive endocrinology in the Chicago area. He is a Founding Partner in Reproductive Medicine Institute. Dr. Rinehart is board certified in the fields of Obstetrics/Gynecology and Reproductive Endocrinology.