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a) What causes these cysts?
A corpus luteum, or functional cyst, is simply a leftover follicle that has outstayed its normal lifespan. Sometimes, they continue to produce progesterone and estrogen, which may delay the arrival of the next period.
b) Will they go away?
Functional cysts almost always go away with time. Birth Control Pills are sometimes prescribed for a month or two, to hasten their resolution. They never need any other intervention. If not, relieved by medication, they may not be functional cysts and need further evaluation.
c) How big do they need to be to reduce chances of pregnancy?
Research has shown that any cyst 10 mm or larger is associated with a lower chance of getting pregnant. Those that had a 10 mm cyst at the beginning of a cycle had half the pregnancy rate of those who had no cysts. It does not eliminate your chances of pregnancy, but it does sharply decrease them, through two mechanisms. First, physically, they can crowd out the development of new follicles. Also, if the cyst is secreting hormones at the wrong time of the cycle, it interferes with the chemical balance required for good quality ovulation and drastically reduces the chances of pregnancy.
It is normal to have small cysts, which may be very small leftover follicles or follicles that are preparing for the next cycle. Anything under 10 mm shouldn't be cause for concern as long as your baseline hormone levels are in range.
After that, you might report to your clinic daily for blood work and ultrasounds. Once your follicles have reached an appropriate size and your E2 levels are good, you stop the stimulation and GnRH, and are given the hCG shot, in the presence of good blood flow. The eggs are retrieved using an ultrasound probe that has a needle at the end of it. They put the needle through the vaginal wall and aspirate the follicles. You will generally start progesterone immediately following the retrieval.
Sometimes, your doctor may change this protocol to a "short protocol", This decision is done during the planning of your cycle, and depends on the indication and other factors involved in individual case.
This decision will depend on your individual case history and the ovarian response to the stimulation drugs.
Often, this may be combined as an operative procedure for correction of any associated pelvic pathology.
If there are too many eggs, there may be a possibility of you developing ovarian hyperstimulation, and your doctor will counsel you for the same. Sometimes, the doctor may also advise cancellation of the current cycle, if the risk is very high.
If there are too few eggs, there maybe another stimulation, which may be needed and your doctor will advise the same. Or, she may ask for certain additional tests to find out the cause of this unexpected result to prevent its recurrence in the next cycle.
The treatment then is just a matter of rest and staying well hydrated. In more severe cases, the estrogen in the peritoneal cavity causes fluid to leak out of the circulatory system into the peritoneal cavity. This can cause marked discomfort and bloating, and can cause difficulty breathing due to pressure on the diaphragm. In the most severe cases, the leaking of the fluid will lead to hypovelmic shock and organ damage because of a lack of perfusion. Generally you do not see severe OHSS until the Estradiol gets into the 5000+ range. As long as your doc keeps a close eye on your dosage and development, the chances of anything other than mild discomfort are minimal.