The Risk of Infertility After Surgery for Benign Ovarian Cysts

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.

Keywords: cystectomy; infertility; ovarian cysts; ovarian reserve; ovarian surgery.

FIG. 1.

Unadjusted and adjusted median HRs and 95% SI examining time from ovarian cyst surgery age to infertility after surgery comparing those who reported a history of ovarian cyst surgery and those assigned a proxy age of surgery who reported no history of ovarian cyst surgery, censored at age of hysterectomy, bilateral oophorectomy, bilateral tubal ligation, or study interview. BMI, body mass index; HR, hazard ratio; PCOS, polycystic ovary syndrome; SI, simulation interval.

FIG. 2.

Adjusted estimates and 95% CI for geometric mean values of AMH and AFC comparing women who reported a history of surgery for ovarian cysts versus no history of surgery for ovarian cysts. AFC, antral follicle count; AMH, anti-Müllerian hormone; CI, confidence interval.