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Ovarian endometriomas affect between 20 and 40 percent of women with endometriosis, a condition in which the tissues that usually line the uterus also grow outside of it in other reproductive organs. Popularly known as "chocolate cysts" because of their appearance and texture, ovarian endometriomas can increase the severity of pre-existing endometriosis symptoms, as well as reducing fertility by negatively impacting egg maturation and hormone levels.

Diagnosed with the help of ultrasound and then biopsy, chocolate cysts in women who wish to try to get pregnant present a real clinical challenge. That is, the cysts themselves reduce fertility, but surgery to remove them can do the same. 

What should you do if you have a chocolate cyst or several and want to try to get pregnant? What are your odds of pregnancy if you have already had a chocolate cyst removed laparoscopically?

What Should You Do If You Have Ovarian Endometriomas And Want To Get Pregnant?

Currently available research is not conclusive enough to offer you a clear path of action. 

There is research suggesting that laparoscopic surgery improves pregnancy rates in women with deep infiltrative endometriosis, whether they have chocolate cysts or not. One study, however, noted that an improve in assisted reproductive techniques in general means that more conservative, "wait and see", approaches, are being explored.

The study found that women who already struggle with infertility to the point that they were already scheduled for IVF do not need to delay their fertility treatment to have their chocolate cysts removed. Having surgery to have your cyst(s) removed, the authors discovered, neither improves your IVF success rates nor affects the amount of pain you will experience. By delaying the surgery, you avoid the risk that the procedure itself will further reduce your fertility. 

Can I Get Pregnant If I Have Already Have A Chocolate Cyst Removed?

If you do have a chocolate cyst removed — based on your doctor's careful assessment and a discussion about the pros and cons — laparoscopic cyst removal is the best available path. Women who have a chocolate cyst drained, on the other hand, are extremely likely to have the cyst come back, leaving you at square one. 

Research has found that pregnancy rates are lower in women who have had chocolate cysts removed than in women who have had surgery to remove other kinds of ovarian cysts. Your chances of pregnancy appear to be better if your cysts were smaller or if you only had one ovarian endometrioma, but they are, unfortunately, lower than they are in women who have not had chocolate cysts. This does not mean you will definitely not be able to get pregnant naturally, but it does mean that you will want to ask your doctor about seeing a fertility specialist sooner than you otherwise would. 

On a positive note, women who underwent chocolate cyst removal and then try to get pregnant with the help of IVF appear to have equal odds of getting pregnant as those who didn't have the surgery.   

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