Abstract
Introduction
The utilization of assisted reproductive technologies (ART) is often a high stakes process for patients that requires significant investment of time and finances. Patients who undergo IVF and frozen embryo transfer (FET) cycles may have their treatment cycle cancelled if there are ovarian cysts present on the initial ultrasound scan. Ovarian cysts detected on baseline ultrasonography warrant careful consideration. A non-functional simple cyst can have an association with a low baseline estradiol (E2) and thus thought not to affect the clinical response to a controlled ovarian hyperstimulation cycle. A functional cyst which releases E2, on the other hand, can adversely alter ovarian response to gonadotropin stimulation. Baseline E2 levels are often used in clinical decision making of whether to proceed with the cycle or not and the cutoff levels may be practice dependent. Further, complex cysts are another type of ovarian cyst which may have a profound negative impact on ovarian reserve and thus also be a cause for suboptimal oocyte and/or embryo quality The objective of this study was to evaluate the impact of the cyst type and baseline E2 levels on IVF and FET outcomes.
Methods
This was a retrospective cohort comparing patients, 18-45 years old undergoing IVF/FET at a multi-center fertility network with baseline ovarian cysts to no ovarian cysts from Oct ‘22 to Dec ‘25. Patients with donor egg cycles, uterine factor, and intact hydrosalpinx were excluded. Primary outcomes were oocytes retrieved and live birth per transfer. Secondary outcomes were mature oocytes (MIIs), 2 pronuclei (2PN) embryos, usable blastocysts, euploidy and clinical pregnancy. Poisson regression evaluated the association between cyst status and reproductive outcomes, adjusting for age and BMI. E2 level was stratified into four groups and evaluated for differences in primary and secondary outcomes.
Results
There were 1,962 simple, 2,405 complex, and 12,097 no cyst cycles. Oocytes retrieved were lower in simple (11, aRR 0.81 [0.78, 0.85]) and complex (11, aRR 0.78 [0.74, 0.81]) versus no cyst cycles (15). Simple (2, aRR 0.83 [0.78, 0.89]) and complex (2, aRR 0.74 [0.69, 0.78]) had less usable blastocysts compared to no cyst cycles (3). Euploidy rate was similar across groups. Clinical pregnancy was lower in simple (51.6%, aRR 0.89 [0.81, 0.98]), but similar in complex (52.6%; aRR 1.06 [1, 1.13]) and no cyst cycles (57.1%). Live birth per transfer were similar in simple (39.1%, aRR 0.89 [0.79, 1.01]) and no cyst cycles (45.4%), but higher in complex cycles (52.6%, aRR 1.08 [1.01, 1.16]). Increasing E2 >50 was associated with fewer oocytes retrieved, MIIs, 2PN embryos, usable blastocysts and a dose-response was not seen with E2 levels. Clinical pregnancy and live birth were similar across E2 groups.
Conclusion
Baseline ovarian cysts were associated with reduced oocyte and blastocyst yields. Simple cysts are linked to lower clinical pregnancy, while complex cysts had similar clinical pregnancy and higher live birth. Elevated E2 >50 predicts poorer oocyte and blastocyst yield, but pregnancy outcomes were similar between groups. Overall, baseline cysts and elevated E2 reduce oocyte yield, but do not compromise live birth per transfer.