A minimally invasive procedure to remove ovarian cysts while preserving healthy ovarian tissue and supporting reproductive health.
The ovary is kept
only the cyst is removed; this is different from removing the whole ovary
Many cysts need no surgery
common functional cysts often settle by themselves within a few cycles
Can lower egg reserve
surgery on the ovary can reduce egg supply, so timing and technique matter
An ovarian cystectomy is an operation to remove a cyst (a fluid-filled or tissue-filled sac) from the ovary while leaving the rest of the ovary in place. It is usually done by laparoscopy (keyhole surgery), through small cuts in the abdomen. A larger cut (open surgery) is sometimes needed for very large cysts or when a cancer is suspected.
It is different from an oophorectomy, in which the whole ovary is removed. Doctors try to avoid removing an ovary in women who may want children, and the consent form should say what will happen if the ovary cannot be saved.
The right decision depends first on what kind of cyst it is, because different cysts behave very differently.
The table shows common types of ovarian cyst and when surgery is usually considered:
| Type of Cyst | Usual Behaviour | When Surgery Is Considered |
|---|---|---|
| Functional cyst (follicular or corpus luteum) | Linked to ovulation; often shrinks on its own within a few cycles | Rarely; if it persists, grows, or causes severe pain or bleeding |
| Endometrioma (“chocolate cyst”) | Caused by endometriosis; does not go away by itself and can return | Pain, rapid growth or large size, or unclear diagnosis; before IVF only in selected cases |
| Dermoid cyst (mature teratoma) | Usually benign and slow-growing; can twist the ovary | Symptoms, larger size, growth over time, or risk of twisting |
| Cystadenoma (serous or mucinous) | Benign but can become very large | Persistent, growing or symptomatic cysts |
| Cyst with suspicious features on scan | Solid areas or unusual blood flow may raise concern for a tumour | Needs specialist assessment; may require a gynaecological oncologist |
| Twisted ovary (torsion) with a cyst | Sudden severe pain; blood supply is cut off | An emergency; the ovary is untwisted and saved where possible |
Polycystic ovaries (PCOS) are a different matter. The many small follicles seen on a scan are not cysts that need to be removed, and cystectomy is not a treatment for PCOS.
The outer layer of the ovary holds the eggs. When a cyst is peeled away, some healthy tissue can be removed or damaged with it. Studies measuring AMH, a blood marker of egg reserve, have found that levels fall after cystectomy, most clearly after removal of endometriomas and when both ovaries are operated on.
Seek medical help promptly if you have fever, severe or worsening abdominal pain, repeated vomiting, heavy bleeding, or redness or discharge from a wound.
Assess before operating. Guidelines from bodies such as ACOG and the RCOG advise careful ultrasound assessment of ovarian cysts and, where features look suspicious, referral to a specialist team before surgery.
Prefer cystectomy over drainage for endometriomas. Removing the cyst wall lowers the chance of the cyst returning compared with simply draining or burning it, although it may reduce reserve more, so the choice should be individual.
Protect the ovary. Ovarian-sparing technique and an experienced surgeon make a real difference, particularly for endometriosis.
Informed consent. You should be told the reasons, the risks, the alternatives, and what may be done if the surgeon finds something unexpected, and consent in writing beforehand.
These are sometimes all described loosely as “cyst surgery”, but they are different operations:
| Feature | Cystectomy | Drainage (Aspiration) | Ablation (Cautery / Laser) | Oophorectomy |
|---|---|---|---|---|
| What it does | Peels out the cyst and its wall, keeping the ovary | Empties the fluid with a needle | Destroys the inner lining of the cyst with heat or laser | Removes the whole ovary |
| Chance of the cyst returning | Lower | High; the fluid often refills | Higher than cystectomy for endometriomas | None on that side |
| Effect on the ovary | Some loss of healthy tissue is possible | Least surgical trauma, but rarely a lasting solution | May damage the ovary too if heat spreads | The ovary and its eggs are lost |
| Typically used when | Most cysts that need surgery in women who want to keep the ovary | Selected simple cysts; not usually for endometriomas | Selected cases where reserve protection is the priority | Suspected cancer, damaged ovary, or completed childbearing |
No. Many cysts, especially functional ones, settle on their own and are watched with a repeat scan. Surgery is considered for cysts that persist, grow, cause troublesome symptoms, look suspicious, or twist the ovary.
It can reduce egg reserve, especially after removal of endometriomas or when both ovaries are operated on. For many women, the remaining eggs are enough, but this should be discussed and measured before and after surgery.
Not routinely. If there is no pain and no other reason for surgery, guidelines generally advise against removing it before IVF, because surgery may reduce egg reserve without improving results. Your doctor will weigh your symptoms, the cyst size and your reserve.
Yes, particularly endometriomas. Hormonal treatment after surgery can lower the chance in women who are not trying to conceive.
In a cystectomy only the cyst is removed and the ovary stays. In an oophorectomy the whole ovary is removed. Doctors try to avoid oophorectomy in women who may want children.
Almost always not. Dermoid cysts are usually benign, but they can grow and twist the ovary, which is why surgery is often advised for larger or symptomatic ones.
Hormonal pills do not usually make an existing functional cyst disappear faster. After endometrioma surgery, hormonal treatment may help reduce recurrence, but it prevents pregnancy while you take it.
This depends on the type of cyst, the surgery, and your reserve. Many women are advised to try or start treatment within a few months, since endometriomas can return. Follow your own doctor’s advice on timing.
Because many women are advised to have cyst surgery without a clear explanation of the reasons, options or effect on their eggs. We believe informed patients make safer decisions, whether or not they choose to be treated with us.
Speak with the StemRx team for a proper evaluation and a straightforward discussion of whether you need surgery, how to protect your egg reserve, and how it fits with your plans for pregnancy.
