Chocolate cysts are formed when endometrial tissue is located within the ovarian tissue. Non-malignant endometriosis is seen in 2% to 10% of women in their reproductive years. These cysts also occur in the ovaries in 17% to 44% of women with chocolate cysts. Since chocolate cysts especially affect women in their reproductive years, it is …
Chocolate cysts are formed when endometrial tissue is located within the ovarian tissue. Non-malignant endometriosis is seen in 2% to 10% of women in their reproductive years. These cysts also occur in the ovaries in 17% to 44% of women with chocolate cysts. Since chocolate cysts especially affect women in their reproductive years, it is very important to plan for ovarian reserve, especially when they occur in the ovaries. Therefore, it is important to be aware of the symptoms of chocolate cysts.
Painful menstrual periods, pelvic pain not related to menstrual periods, irregular menstrual periods, pain during sexual intercourse and infertility are examples of symptoms caused by chocolate cysts. There has been a debate for many years that chocolate cyst treatment with laparoscopy or open surgery reduces ovarian reserve. Although there is a visible relationship between chocolate cysts and infertility, the causes of this are still not known for sure.
Chocolate Cyst Effect on Ovaries
According to the studies, chocolate cysts that occur in the ovaries have important effects. The ovarian tissue around the cyst wall is morphologically deteriorated and has lost its functionality. Chocolate cysts can affect ovarian reserve in two ways.
The first of these is that the circulation in the ovarian cortex is disrupted by the compression of the cyst and therefore follicle loss occurs. Over time, the follicular density in the cyst wall decreases significantly compared to the normal ovarian cortical tissue. The second is the formation of an infected environment within the cyst walls that causes follicular damage. The most reliable indicators used to determine the number of ovarian reserve are the number of antral follicles and anti-mullerian hormone levels. In addition, the number of oocytes obtained in assisted reproductive techniques is also considered an important indicator of ovarian reserve.
Chocolate Cyst Treatment and Ovarian Reserve
The effect of chocolate cysts on the ovaries is structurally different from other cysts. In dermoid cyst, cystadillonoma or mucinous cystadillonoma surgeries, approximately 6% of the ovarian tissue is removed. In chocolate cyst surgeries, this rate varies between 54% and 69%. According to research, after the chocolate cyst in the ovaries is surgically removed, there is a decrease of approximately 38% in the levels of antimullerian hormone. There is no significant change in the number of antral follicles. However, surgery is not the only treatment method for chocolate cysts. In some cases, cysts can be reduced in size with drug treatments. In women who want to get pregnant and have large chocolate cysts, we perform hormonal suppression after emptying the cyst with a simple procedure. Then, we start in vitro fertilization treatment.
