Ovarian cysts decrease the success of controlled ovarian stimulation and in vitro fertilization

Forty cystic structures, 16 to 60mm, of probable ovarian origin were found in 126 cycles during an ultrasound scan on day 3 of a cycle in which in vitro fertilization was planned. The response of these patients to exogenous gonadotropin stimulation, oocyte capture, fertilization, cleavage, and pregnancy was studied. Patients with cystic change had significantly lower peak estradiol (E2) levels. Pregnancy rates were lower, but not significantly so. Those patients with structures 16 to 29mm had more cycles canceled due to precipitous drops in E2, consistent with an untimely surge of luteinizing hormone. Patients with structures 30 to 60mm had increased numbers of cycles with poor response to stimulation. The importance of an early follicular phase ultrasound scan is stressed, and the management of ovarian cysts in this patient population is discussed.