Can an Ovarian Dermoid Cyst Cause Infertility Problems?

For many patients, hearing they have an ovarian mass brings up immediate fears about cancer and their ability to have children. The reassuring news is that an ovarian dermoid cyst—also called a mature cystic teratoma—is typically benign (non-cancerous). Furthermore, a straightforward, one-sided (unilateral) dermoid cyst usually does not directly cause infertility or prevent natural conception.

These cysts are generally confined to the ovary itself. They typically do not physically switch off ovulation, block your fallopian tubes, or prevent a fertilized egg from implanting in your uterus ^[1]. In fact, it is very common for people with dermoid cysts to get pregnant naturally, and sometimes these cysts are only discovered by chance during a routine pregnancy ultrasound ^[2].

However, while a dermoid cyst itself rarely causes direct infertility, it can impact your reproductive health indirectly through physical complications, coexisting conditions, or the potential side effects of surgery.

Monitoring vs. Surgery

The presence of a dermoid cyst does not automatically mean you need surgery. The decision depends on the cyst’s size, ultrasound features, growth rate, and whether you are experiencing symptoms ^[3][4].

• Expectant Management (Monitoring): For small, asymptomatic, and benign-appearing cysts, your doctor may recommend monitoring the cyst with periodic ultrasounds. You can usually safely continue trying to conceive during this time.
• Ovarian Cystectomy: If surgery is recommended, the goal is usually a cystectomy—removing the cyst while attempting to leave the healthy ovarian tissue intact.
• Oophorectomy: In rarer cases where the ovary is extensively damaged (such as from prolonged torsion or bleeding), the entire ovary may need to be removed. Even then, one healthy remaining ovary is often sufficient to release eggs and support a pregnancy.

If you are trying to conceive and have been unsuccessful, it is important to undergo a standard infertility workup rather than assuming the dermoid is the cause. This includes checking ovulation, fallopian tube health, and your partner’s sperm quality.

Factors That Can Affect Your Fertility

When assessing how a dermoid cyst might impact your future fertility, doctors look at several specific indirect factors:

• Ovarian Torsion (Medical Emergency): Because dermoid cysts contain heavy tissues, they can cause the ovary to twist on its supportive ligaments, cutting off its blood supply ^[5]. Warning signs include sudden, severe one-sided pelvic or lower-abdominal pain, often accompanied by nausea, vomiting, or faintness. If you experience these symptoms, do not wait for a routine appointment—go to the emergency room immediately ^[6]. Prompt surgery can often untwist and save the ovary; however, prolonged torsion can permanently destroy the ovarian tissue ^[7]. While some research suggests larger cysts carry a higher risk of torsion, it can happen with cysts of any size ^[2][8].
• Bilateral Cysts: Most dermoid cysts only affect one ovary. If you have cysts on both ovaries (bilateral disease), any damage to the tissue—or the need for surgery on both sides—can lower your overall fertility potential ^[9].
• Cyst Rupture: Though rare, a dermoid cyst can burst, causing sudden severe pain. The contents of the cyst can irritate the inside of your pelvis (chemical peritonitis) and cause scar tissue (adhesions) to form around your pelvic organs ^[10]. Severe scar tissue can theoretically interfere with your fallopian tubes’ mobility and ability to pick up an egg.
• Coexisting Endometriosis: If you are experiencing infertility and happen to have a dermoid cyst, the cyst itself may not be the actual culprit. In some studies of patients having surgery for a dermoid cyst, up to 20% were found to also have endometriosis ^[11][12]. The dermoid does not cause endometriosis, but the two conditions can coexist, and endometriosis is strongly linked to pelvic pain and difficulty getting pregnant.

Ovarian Reserve (AMH) vs. Getting Pregnant

If you are discussing fertility and dermoid cysts with your doctor, your care team might mention testing your Anti-Müllerian Hormone (AMH) or performing an ultrasound to check your antral follicle count. These optional tests estimate your ovarian reserve—roughly the quantity of eggs you have remaining.

It is critical to understand that AMH is not a direct test of your ability to get pregnant spontaneously in any given month ^[13]. A low AMH level does not automatically mean you are infertile, and a normal AMH level does not guarantee you will get pregnant, because the test does not measure egg quality, tubal health, or sperm quality.

If you need a cystectomy to remove the dermoid cyst, it is common for your AMH levels to drop temporarily afterward ^[14]. This happens because some healthy ovarian tissue may be removed or affected by surgical techniques like cautery (using heat to stop bleeding). While this decline in AMH can recover, it is sometimes lasting, especially if you have bilateral cysts or coexisting endometriosis ^[11]. However, a drop in this laboratory value does not strictly equal a drop in your ability to conceive naturally.

When to Seek a Fertility Evaluation

Discussions about fertility preservation should be highly individualized. You should seek a formal infertility evaluation or consult a reproductive endocrinologist (a specialized fertility doctor) if:

• Based on Time Trying: You are under 35 and have been actively trying to conceive for 12 months; you are 35 to 39 and have been trying for 6 months; or you are 40 or older (which warrants prompt evaluation).
• Based on Risk Factors: You have cysts on both ovaries, known diminished ovarian reserve, irregular menstrual cycles, suspected endometriosis, or a history of prior ovarian surgeries ^[15][11].