Reproductive Endocrinology and Infertility · Mature Cystic Teratoma

Should a Dermoid Cyst Be Removed Before Pregnancy or IVF?

At a Glance

An ovarian dermoid cyst does not always need removal before pregnancy or IVF. Small, symptom-free cysts with a typical benign ultrasound appearance may be monitored; surgery is more often considered for pain, rapid growth, suspicious features, or blocked egg retrieval, and can reduce ovarian reserve.

There is no universal rule that every ovarian dermoid cyst (mature cystic teratoma) must be removed before you try to conceive or start In Vitro Fertilization (IVF). The decision requires a careful balancing act between the risks of leaving the cyst in place—such as it twisting or getting in the way of egg retrieval—and the risks of surgery, which can reduce your ovarian reserve (the pool of remaining eggs) ^[1]^[2]^[3].

Because every patient’s situation is different, expectant management (careful observation with periodic ultrasounds) is often a reasonable option for small, asymptomatic cysts that have a classic benign appearance on imaging ^[3]. Removing an asymptomatic, benign dermoid does not automatically improve your natural fertility or IVF success ^[4].

🚨 When to Seek Urgent Care
While most dermoid cysts are slow-growing and painless, they can increase the risk of the ovary twisting (ovarian torsion). If you experience sudden, severe, one-sided pelvic or lower abdominal pain—especially if accompanied by nausea, vomiting, faintness, or fever—go to the emergency room immediately. Do not wait for a routine appointment. Intermittent severe pain can also be a sign of the ovary twisting and untwisting ^[5].

The Risks of Leaving the Cyst

When considering whether to monitor the cyst rather than operate, doctors look at the likelihood of complications during pregnancy or fertility treatments.

Ovarian Torsion: Torsion happens when the weight of the cyst causes the ovary to twist, cutting off its blood supply. This is a medical emergency that can occur during pregnancy ^[6]^[7]. While a cyst increases this risk (particularly as it grows larger, with some studies noting higher torsion rates in cysts over 5 cm), torsion is still an uncommon event for any individual patient ^[8]^[9].
Rupture: Though rare, a dermoid cyst can spontaneously rupture. If the cyst contents spill into the abdomen, it can cause chemical peritonitis—a severe inflammatory reaction that requires urgent surgery ^[10].
Interference with IVF: A cyst might physically block the needle path used to retrieve eggs from the ovary. However, this depends entirely on the cyst’s location and the location of your developing follicles. A cyst does not automatically prevent egg retrieval; your reproductive endocrinologist will review your ultrasound to determine if the follicles can still be safely accessed.

The Risks of Surgery (Cystectomy)

Surgery to remove the cyst (cystectomy) carries standard surgical risks like bleeding, infection, and scar tissue (adhesions). Most importantly for fertility patients, removing a cyst almost always involves the removal or damage of some healthy ovarian tissue ^[11].

Changes in Ovarian Reserve: Studies consistently show that levels of Anti-Müllerian Hormone (AMH)—a blood test used to estimate your ovarian reserve and predict your response to IVF medications—drop after a cystectomy ^[12]^[13]. AMH does not directly measure egg quality or predict your chances of natural conception, but it is an important marker for IVF planning.
Surgical Techniques: The methods used to stop bleeding during surgery matter. For instance, using heat (electrocoagulation) to control bleeding can cause more damage to healthy ovarian tissue than using stitches ^[14]^[15].
Recovery of AMH: While AMH levels often partially recover a few months after surgery, they may not return to their original baseline, and the drop can sometimes be persistent ^[16]^[17].
High-Risk Scenarios: The risk to your fertility is significantly higher if you have cysts in both ovaries (bilateral), only one functioning ovary, prior ovarian surgeries, or if your AMH is already low ^[18].

When is Surgery the Best Option?

Observation is appropriate for many, but your medical team might strongly recommend surgery before pregnancy or IVF if:

The cyst has an atypical or indeterminate appearance: Dermoids naturally contain solid-appearing materials like fat and hair. However, if the ultrasound shows atypical features, irregular vascular nodules, or rapid growth, expert review and surgery may be needed to rule out the very rare chance of a malignancy ^[19]^[20].
You are having symptoms: Chronic pain, pressure, or episodes of severe pain suggest the cyst may be twisting or causing other issues.
It is large or growing rapidly: There is no single size rule, but cysts that are very large or growing quickly carry a higher risk of torsion and surgical complications ^[1]^[9].
It blocks IVF access: If the fertility doctor determines the cyst makes retrieving eggs from that ovary unsafe or impossible.

Creating a Coordinated Plan

If you have a dermoid cyst and are planning for a family, your care should be a coordinated effort between a reproductive endocrinologist (fertility specialist) and a minimally invasive gynecologic surgeon.

For some patients, doctors may recommend undergoing IVF to retrieve eggs and freeze embryos before the cyst is removed ^[21]. This ensures your eggs are safely banked before exposing your ovaries to the risks of surgery. However, this is highly individualized; ovarian stimulation takes time, and delaying surgery may not be safe if your cyst is painful, very large, or suspicious on ultrasound.

Common questions in this guide

Does every ovarian dermoid cyst need to be removed before pregnancy or IVF?

No. A small cyst that causes no symptoms and has a classic benign appearance on ultrasound can often be monitored with periodic scans. The decision depends on its size, location, growth, symptoms, and how it may affect egg retrieval.

Can an ovarian dermoid cyst interfere with IVF egg retrieval?

Sometimes, but not always. The cyst can block the needle’s path to follicles, depending on its location and the position of the developing follicles. A reproductive endocrinologist can use ultrasound to decide whether retrieval is safe without removing the cyst.

Could dermoid cyst surgery lower my ovarian reserve?

Yes. Cystectomy can remove or injure healthy ovarian tissue, and AMH, a marker of ovarian reserve, often falls after surgery, although it may partially recover over the following months. The effect may be more concerning when cysts affect both ovaries, there is only one functioning ovary, prior ovarian surgery, or AMH is already low.

When might surgery be recommended before trying to conceive?

Surgery is more likely to be recommended when the cyst causes pain, is very large or growing quickly, has an atypical or suspicious ultrasound appearance, or makes IVF egg retrieval unsafe. These findings do not create one automatic size rule; the recommendation depends on the whole clinical picture.

Should I freeze eggs or embryos before a dermoid cyst is removed?

Some patients may be advised to undergo IVF and freeze eggs or embryos before cystectomy, especially when protecting ovarian reserve is a concern. This is individualized based on age, AMH, cyst symptoms and appearance, ovarian function, and whether delaying surgery is safe.

What symptoms of an ovarian dermoid cyst require emergency care?

Sudden severe pain on one side of the pelvis or lower abdomen may signal ovarian torsion, when the ovary twists, especially with nausea, vomiting, faintness, or fever. Seek emergency care immediately rather than waiting for a routine appointment.

Answer a question to get research tailored to you. Your answers are private.

Related questions

Is Exercise or Sex Safe With an Ovarian Dermoid Cyst? Can an Ovarian Dermoid Cyst Cause Infertility Problems? How Is an Ovarian Dermoid Cyst Treated After Menopause? Ovarian Dermoid Cysts: Do They Cause Irregular Periods? Does a 5 cm Ovarian Dermoid Cyst Always Require Surgery?

Is an Ovarian Dermoid Cyst Dangerous During Pregnancy? What Do Ovarian Dermoid Cysts Look Like on Imaging? Can a Dermoid Cyst Be Drained or Popped Instead of Removed? What Specialist Treats a Dermoid Cyst by Location? What Causes a Dermoid Cyst, and Are They Hereditary? What Are the Symptoms of an Infected Dermoid Cyst? Can You Prevent a Dermoid Cyst from Forming or Coming Back? What Are Dermoid, Epidermoid, 'Sebaceous' & Pilonidal Cysts? How Is a Dermoid Cyst Diagnosed Without Surgery? Imaging How Often Should an Ovarian Dermoid Cyst Get Ultrasound? Can the Ovary Be Saved After Torsion From a Dermoid Cyst? Can Birth Control Pills Shrink an Ovarian Dermoid Cyst? Can Doppler Ultrasound Miss Torsion From a Dermoid Cyst? How Is Fertility Preserved With Bilateral Dermoid Cysts?

Get notified when new evidence is published on dermoid cyst.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

Curated prompts to bring to your next appointment.

1.What is my cyst's exact size, location, and appearance, and has it changed since my last scan?
2.Will this cyst block your ability to safely retrieve eggs from that ovary during IVF, and what is my expected egg yield with and without surgery?
3.If I need surgery, what techniques will you use to preserve as much of my healthy ovarian tissue as possible?
4.Given my current AMH, age, and whether the cyst is in one or both ovaries, should we freeze embryos or eggs before attempting to remove it?
5.What specific ultrasound findings or symptoms would make you recommend changing our plan from observation to surgery?

References (21)

1
Intraoperative Rupture of Ovarian Dermoid Cysts in the Pediatric and Adolescent Population: Should This Change Your Surgical Management?
Childress KJ, Santos XM, Perez-Milicua G, et al.
Journal of pediatric and adolescent gynecology 2017; (30(6)):636-640 doi:10.1016/j.jpag.2017.03.139.
PMID: 28336475
2
Ovarian Mature Cystic Teratoma: Challenges of Surgical Management.
Sinha A, Ewies AA
Obstetrics and gynecology international 2016; (2016()):2390178 doi:10.1155/2016/2390178.
PMID: 27110246
3
Long-term Results for Expectant Management of Ultrasonographically Diagnosed Benign Ovarian Teratomas.
Pascual MA, Graupera B, Pedrero C, et al.
Obstetrics and gynecology 2017; (130(6)):1244-1250 doi:10.1097/AOG.0000000000002327.
PMID: 29112653
4
Effects of mature cystic teratoma on reproductive health and malignant transformation: A retrospective analysis of 80 cases
Kurt S, Avşar HA, Doğan ÖE, et al.
Journal of the Turkish German Gynecological Association 2019; (20(2)):84-88 doi:10.4274/jtgga.galenos.2018.2018.0003.
PMID: 29755032
5
Complete adnexal torsion of a large dermoid ovarian cyst with ovarian and tubal preservation in a 17-year-old patient: a case report.
Thanasa A, Thanasa E, Kamaretsos E, et al.
The Pan African medical journal 2026; (53()):50 doi:10.11604/pamj.2026.53.50.40749.
PMID: 42283041
6
A Rare Case of Ovarian Dermoid Torsion in the Third Trimester: Clinical Challenges and Surgical Management.
Saleem R, Sathyendran P, Askalany T, Mo R
Cureus 2025; (17(10)):e95643 doi:10.7759/cureus.95643.
PMID: 41322865
7
Ovarian preservation in a pregnant woman with a leaking dermoid cyst and ovarian torsion: a case study and review of diagnostic and therapeutic challenges.
Aminzade Z, Azarinoush G, Larijani A, et al.
International journal of surgery case reports 2026; (138(6)):2116-2121 doi:10.1097/RC9.0000000000000110.
PMID: 42253664
8
Dermoid cysts causing adnexal torsion: What are the risk factors?
Rabinovich I, Pekar-Zlotin M, Bliman-Tal Y, et al.
European journal of obstetrics, gynecology, and reproductive biology 2020; (251()):20-22 doi:10.1016/j.ejogrb.2020.05.033.
PMID: 32473535
9
Clinical and ultrasound features of dermoid-associated adnexal torsion.
Shen L, Tse JR, Negrete LM, et al.
Abdominal radiology (New York) 2022; (47(10)):3583-3593 doi:10.1007/s00261-022-03601-6.
PMID: 35809127
10
Ruptured Ovarian Mature Teratoma in a Pregnant Woman with Severe Chemical Peritonitis: A Case Report.
Fernandes GN, Thill K, Sharma V, Igel C
The American journal of case reports 2024; (25()):e944814 doi:10.12659/AJCR.944814.
PMID: 39316566
11
Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst.
Karadağ C, Demircan S, Turgut A, Çalışkan E
Turkish journal of obstetrics and gynecology 2020; (17(1)):15-20 doi:10.4274/tjod.galenos.2020.37605.
PMID: 32341825
12
Effect of barbed suture versus conventional suture in laparo-endoscopic single-site cystectomy for ovarian mature cystic teratoma: An ambispective cohort study.
Liang Y, Liu J, Yu Y, et al.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2023; (161(1)):93-99 doi:10.1002/ijgo.14492.
PMID: 36226665
13
Comparison of early postoperative decline of serum antiMüllerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis.
Chun S, Cho HJ, Ji YI
Taiwanese journal of obstetrics & gynecology 2016; (55(5)):641-645 doi:10.1016/j.tjog.2015.06.016.
PMID: 27751408
14
Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy.
Sahin C, Akdemir A, Ergenoglu AM, et al.
Reproductive sciences (Thousand Oaks, Calif.) 2017; (24(3)):393-399 doi:10.1177/1933719116657195.
PMID: 27436368
15
Changes in ovarian reserve function after laparoscopic ovarian cystectomy: a retrospective cohort study.
Yu J, Liu S, Wang C, Tao N
Frontiers in surgery 2026; (13()):1822536 doi:10.3389/fsurg.2026.1822536.
PMID: 42440542
16
Effect of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Benign Ovarian Cysts.
Sireesha MU, Chitra T, Subbaiah M, Nandeesha H
Journal of human reproductive sciences 2021; (14(1)):56-60 doi:10.4103/jhrs.JHRS_94_20.
PMID: 34083993
17
The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy.
Li H, Yan B, Wang Y, et al.
Frontiers in endocrinology 2021; (12()):671225 doi:10.3389/fendo.2021.671225.
PMID: 34630317
18
Risk factors for a marked decline in anti-Müllerian hormone after minimally invasive ovarian cystectomy: A retrospective cohort study.
Jang EB, Kook YS, Lee AJ, et al.
Medicine 2026; (105(35)):e50473 doi:10.1097/MD.0000000000050473.
PMID: 42675751
19
Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: a Taiwanese Gynecologic Oncology Group (TGOG) study.
Chiang AJ, Chen MY, Weng CS, et al.
Journal of gynecologic oncology 2017; (28(5)):e69 doi:10.3802/jgo.2017.28.e69.
PMID: 28657230
20
Imaging in gynecological disease (31): clinical and ultrasound characteristics of ovarian mature cystic teratomas containing malignancies.
Giudice MT, Moro F, Pozzati F, et al.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2026; (67(6)):852-863 doi:10.1002/uog.70224.
PMID: 42552511
21
Successful in vitro fertilization pregnancy and delivery after a fertility-sparing laparoscopic operation in a patient with a papillary thyroid carcinoma arising from a mature cystic teratoma.
Hong K, Han AKW, Kim ML, et al.
Clinical and experimental reproductive medicine 2019; (46(3)):140-145 doi:10.5653/cerm.2018.00304.
PMID: 31401818

This page is for informational purposes only and does not constitute medical advice. Your reproductive endocrinologist and gynecologic surgeon should help you decide whether observation, fertility preservation, or cystectomy is safest for your situation.