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Uterine and Pelvic Conditions · Ovarian and Adnexal Conditions

The Risk of Infertility After Surgery for Benign Ovarian Cysts

Shandley LM, Spencer JB, Kipling LM, Hussain B, Mertens AC, Howards PP

Published May 2023 Journal of women's health (2002), 32(5), 574-582
DOI 10.1089/jwh.2022.0385 PMID 36971598 PMC PMC10171942

RRM Academy Synopsis

Women with past ovarian cyst surgery reported more infertility

Women who had surgery for a benign ovarian cyst more often reported infertility, in an interview study of 1,537 women aged 22 to 45. Infertility after surgery was more common, with an adjusted hazard ratio of 2.41. AMH, a blood marker of egg supply, looked similar in a small clinic group.

Key Findings

  • Of 1,537 women analyzed, 94 (6.1%) reported cyst surgery. Median age at surgery was 25 years, and the median gap from surgery to interview was 12 years.
  • After accounting for age, race, BMI, cancer history, earlier births, earlier infertility and endometriosis, infertility after surgery was more common (hazard ratio 2.41, 95% simulation interval 1.03–6.78).
  • Women with cyst surgery more often reported ever having 12 months of infertility: 43.6% versus 34.0% without surgery. Among those trying to conceive, the figures were 26.6% and 17.3%.
  • Among women trying to get pregnant, the hazard ratio was 3.09 (95% simulation interval 1.10–15.58). Leaving out women with PCOS (now PMOS, polyendocrine metabolic ovarian syndrome) or endometriosis gave 2.08 (0.87–6.26).
  • Of 514 women at the clinic visit, 28 reported cyst surgery. AMH looked similar between groups, and the authors call their AMH estimates imprecise because the sample was small.

Interpretation

The authors analyzed a survey cohort built to study cancer survivors. Women reported surgery and infertility by telephone, with no records check, and cyst type and surgical technique were unknown. Conditions that cause cysts may also affect fertility, so the authors write that they cannot separate the surgery's effect from those conditions. The main interval begins just above 1, and the clinic group was small. Participants lived in Georgia and had no gonadotoxic cancer treatment. The design shows association only.

RRM Context

The authors name endometriosis as one condition that can lead to cysts needing surgery and might also affect fertility. Restorative reproductive medicine asks what caused the cyst. Infertility is a symptom of an underlying condition that needs diagnosis. The study recorded no cyst type or surgical technique, so it cannot compare operations.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve. However, it is unclear whether ovarian cyst surgery puts women at risk of future infertility. This study investigates whether surgery for benign ovarian cysts is associated with long-term infertility risk.

Methods

Women aged 22-45 years (n = 1,537) were invited to participate in an interview about their reproductive histories, including whether they ever had infertility or ovarian cyst surgery. Each woman reporting cyst surgery was randomly matched to a comparison woman, who was assigned an artificial surgery age equal to that of her match. Matching was repeated 1,000 times. Adjusted Cox models were fit to examine time to infertility after surgery for each match. A subset of women was invited to participate in a clinic visit to assess markers of ovarian reserve (anti-Müllerian hormone [AMH], antral follicle count).

Results

Approximately 6.1% of women reported cyst surgery. Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78). The estimated geometric mean (95% confidence interval [CI]) AMH levels of those who reported a history of ovarian cyst surgery were 1.08 (95% CI: 0.57-2.05) times those of women who reported no history of surgery.

Conclusions

Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.

Topics

By this author

Related research

Uterine and Pelvic Conditions › Ovarian and Adnexal Conditions › Ovarian Cysts · Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation
Lisa M Shandley, Jessica B Spencer, Lauren M Kipling, Banna Hussain, Ann C Mertens, Penelope P Howards
L Shandley, Jess Spencer, J Spencer, L Kipling, B Hussain, A Mertens, P Howards
PMID 36971598 36971598 DOI 10.1089/jwh.2022.0385 10.1089/jwh.2022.0385 Shandley et al. 2023, Shandley 2023

Keywords

cystectomy, infertility, ovarian cysts, ovarian reserve, ovarian surgery

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