Evaluating the effect of simple follicular cysts on clinical pregnancy outcomes in in-vitro fertilization cycles

Purpose

To compare clinical pregnancy outcomes between patients with and without cysts observed on baseline ultrasound at the beginning of an in-vitro fertilization (IVF) cycle and to provide guidance on how to manage IVF cycles in patients presenting with simple follicular cysts.

Methods

Patients who were admitted to the hospital aged 18–45 years and diagnosed as having follicle cysts measuring > 10 mm at the beginning of an IVF cycle, were included in the study as the cyst group. The control group was selected in a way that would be compatible with the age of the cyst group and the causes of infertility. Cyst diameters were also divided into three groups as 10–15 mm, 16–20 mm, and > 21 mm. The patients’ anti-mullerian hormone levels, the presence of cysts, serum estradiol, luteinizing hormone and progesterone levels, the number of oocytes retrieved, the number of embryos, the fertilization rate, the clinical pregnancy outcome, and the live birth rate were evaluated.

Results

There was no statistically significant difference between the cyst and control groups in terms of clinical pregnancy, live birth rates, and miscarriage rates. Total antral follicle count was significantly higher in the clinical pregnancy group than in the non-pregnancy group. In the cyst group, the mean serum E2 value on the day of ovulation trigger day was significantly higher in the non-cycle cancellation group than in the cycle cancellation group. The cyst diameter values were analyzed in relation to cycle cancellation using ROC analysis and the cut-off value was determined as 14 mm, calculated based on the Youden Index.

Conclusion

In follicles < 14 mm, cycles can be started without hesitation. Although pregnancy rates tend to decline in patients with cysts ≥ 21 mm, the difference remains statistically insignificant. Prospective randomized controlled studies with a high number of patients are needed on this subject.