How Is Fertility Preserved With Bilateral Dermoid Cysts?

If you have been diagnosed with mature cystic teratomas (dermoid cysts) in both ovaries, treatment can often still protect your fertility. Having cysts in both ovaries does not automatically mean you will lose both ovaries or your ability to have a future pregnancy ^[1].

The first decision is whether you need surgery right away. Small, asymptomatic dermoid cysts can sometimes be safely monitored with regular ultrasounds ^[2]. However, if your cysts are large, growing, causing symptoms, or have suspicious features on imaging, surgery is usually recommended ^[2]. When surgery is indicated and you want to preserve your fertility, the preferred treatment is ovarian cystectomy—a procedure that carefully removes the cyst while leaving the healthy, egg-producing tissue intact ^[3][4].

Because operating on both ovaries carries a higher risk of lowering your overall egg supply compared to operating on just one, your care team should assess your ovarian reserve and discuss all your options, including fertility preservation, before heading into the operating room ^[5].

⚠️ When to Seek Urgent Care

If you experience sudden, severe pelvic pain, especially with nausea, vomiting, or fainting, seek emergency medical care immediately. These are signs of ovarian torsion, where the weight of a cyst causes the ovary to twist and cut off its blood supply. Prompt emergency surgery to untwist the ovary is the best way to save the ovarian tissue and protect your fertility ^[2][3].

Knowing Your Ovarian Reserve Before Surgery

Every time a cyst is removed, a small amount of healthy ovarian tissue can be lost, which may decrease your ovarian reserve (your remaining egg supply) ^[6][7]. Because you have cysts in both ovaries, your doctor will likely check your baseline reserve before planning surgery using two tests:

• AMH (Anti-Müllerian Hormone) blood test: A hormone level that helps estimate the size of your remaining egg supply ^[8].
• Antral Follicle Count (AFC): An ultrasound measurement that counts the small, resting egg follicles in your ovaries ^[8].

It is important to understand that these tests estimate the quantity of your eggs, not their quality. They do not guarantee natural fertility, as factors like your age, fallopian tubes, and sperm health also matter ^[9]. Surgery for dermoid cysts can cause AMH levels to drop. While these levels sometimes partially recover a few months after surgery ^[10], this rebound does not mean lost eggs have grown back. Knowing your starting point helps you and your doctor make informed decisions about how and when to operate ^[9].

Freezing Eggs or Embryos Before Treatment

If your tests show that your egg supply is already low, or if your cysts are complex, your doctor may recommend consulting with a reproductive endocrinologist (fertility specialist) before your cyst surgery ^[5]. You may have the option to undergo oocyte cryopreservation (egg freezing) or embryo freezing (which requires sperm from a partner or donor) ^[8][11].

By freezing eggs or embryos before your ovaries undergo surgical stress, you can improve your options for your future family-building goals ^[5]. However, cryopreservation does not guarantee a future pregnancy, and the process requires time, medications, and financial cost. If you have an urgent medical situation like torsion or suspected cancer, you may not have time to complete a freezing cycle before surgery ^[8].

Choosing the Right Surgery

Ovarian Cystectomy

Whenever possible, surgeons perform an ovarian cystectomy, peeling the dermoid cyst away from the normal ovarian tissue ^[3]. Successful pregnancies and live births have been well-documented in patients who have had cystectomies on both ovaries ^[12][13].

Surgeons use specific techniques to help protect your remaining eggs. For example, limiting the use of heat or electrical energy (thermocoagulation) to stop bleeding may help prevent damage to the healthy tissue nearby, though bleeding control remains the priority ^[14][15]. Surgeons also frequently use a surgical “endobag” to capture the cyst before removing it, which reduces the chance of the cyst’s contents spilling and causing inflammation or scar tissue (adhesions) ^[16]. While these techniques help, no surgical method completely eliminates the risk of some reserve loss or adhesion formation ^[15].

Operating All at Once vs. In Stages

If both ovaries need treatment, you and your surgeon will decide whether to remove both cysts during a single surgery or to perform staged surgeries (operating on one ovary, allowing you to recover, and then operating on the second one later).

• Single surgery: Both cysts are removed in one operation, meaning you only go under anesthesia once and have a single recovery period. This has been safely and successfully performed in many cases ^[5].
• Staged surgery: This might be considered if your egg supply is very low, the cysts are massive, or the surgery is expected to be exceptionally difficult ^[17]. However, staging requires a second surgery with additional anesthesia, risks further scar tissue, and carries the chance that the remaining cyst could grow or twist while you wait.

There is no universally “safest” approach. The decision must be individualized based on your symptoms, cyst sizes, and specialist judgment ^[17][5].

The Risk of Cysts Returning

Dermoid cysts can sometimes grow back. Young women and those with cysts in both ovaries have a higher risk of recurrence; one large study of young patients found that about 11% experienced a recurrence within 5 years of a cystectomy ^[18].

Because repeat surgeries on the same ovary can cause further damage to your egg supply ^[19], preventing unnecessary surgeries is crucial. Your doctor will likely recommend routine, individualized ultrasound check-ups to monitor your ovaries so that any new growth can be watched closely rather than immediately rushing into another surgery ^[20].

When Removing an Ovary is Necessary

While preserving the ovary is the goal, there are situations where an oophorectomy (removal of the entire ovary) is the safest medical choice:

• Lack of healthy tissue: If a giant cyst has completely replaced the normal ovarian tissue, there may not be any functional tissue left to save ^[21].
• Severe tissue damage from torsion: If a cyst causes the ovary to twist, surgeons will typically untwist it and attempt to save it, even if the tissue looks dark or damaged ^[22]. However, if the tissue is completely non-viable and cannot be salvaged, the ovary must be removed ^[22].
• Suspicion of cancer: Malignant transformation in dermoid cysts is very rare ^[23]. While dermoids naturally contain solid elements, if your ultrasound shows highly irregular features, rapid growth, or if you are past menopause, the safest option may be to remove the entire ovary intact ^[23]. In these cases, a gynecologic oncologist should be involved in your care ^[23].

If one ovary must be removed, try not to panic. Many people can conceive naturally with just one healthy ovary, as it is often fully capable of producing the hormones and eggs needed for a healthy pregnancy ^[4].