FOLLICULAR OVARIAN CYSTS: IMPACT ON OVULATORY FUNCTION AND REPRODUCTIVE PROSPECTS

Abstract

Follicular cysts are the most common type of functional ovarian cyst and arise when a dominant follicle fails to rupture at the expected point in the menstrual cycle, most often as a result of excessive follicle-stimulating hormone drive or an absent or blunted luteinizing hormone surge. Although the majority of these cysts are asymptomatic and resolve spontaneously, their presence raises persistent clinical questions about their effect on ovulatory regularity, the outcome of assisted reproduction cycles, and long-term reproductive prospects, particularly when surgical intervention is considered. This review synthesizes evidence on the pathophysiology of follicular cyst formation, standardized ultrasound classification of physiologic versus pathologic adnexal findings, the measurable effect of baseline follicular cysts on clinical pregnancy outcomes during in vitro fertilization, and the impact of cystectomy on ovarian reserve markers. Randomized and systematic-review evidence indicates that hormonal treatment does not accelerate the resolution of established functional cysts and that small cysts, below approximately 14 mm, do not meaningfully compromise IVF cycle outcomes, whereas surgical stripping of larger or recurrent cysts, especially when bilateral, carries a demonstrable risk to ovarian reserve as reflected by anti-Müllerian hormone decline. These findings support individualized, biomarker-guided management that favors conservative observation over reflexive hormonal or surgical intervention whenever clinically appropriate, in order to preserve ovulatory and reproductive potential.