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Infertility/Fertility/Prepping for IVF and Cyst Found


Hi Dr. Ramirez,

I've been diagnosed with unexplained infertility and am doing my first IVF this cycle.  In all of my monitored cycles (and there have been many) - I have never developed cysts other than the corpus luteum - my follies always seem to ovulate just fine.  This cycle in preparation for the IVF, my RE had me start birth control pills on day 5 of my cycle after getting my period.  I did not do a baseline ultrasound and had not been on any drugs the cycle prior.  I usually ovulate around day 11-12 with a dominant follie around 17-18mm a day or two before ovulation.

I went in yesterday (day 13 of my cycle - approx. day 8 of birth control pills) for a mock embryo transfer and my RE noticed while looking at my ovaries that I have one 20mm cyst.  I figure this is a physiologic cyst as you have described previously.  I was scheduled to be on birth control pills for another 10 days (18 in total) and then come in the day after for my baseline scan.  My RE said at that scan we will be able to see if the cyst is producing estrogen if it is still around. My question is how likely will it disappear with only another 10 days left on bcps?  If it is still around and not producing estrogen, would you recommend to still proceed?  Might that result in less follicles on that ovary because much of the real estate so to speak is taken up by a cyst?

Many thanks as always for your insight.


Hello Sunny from the U.S. (D.C.),

The cyst you have is most likely an ovulatory cyst, and I would guess that you had breakthrough ovulation due to too low a dosage on the OCP (breakthrough ovulation).  I would recommend that you stay on the OCP and it should resolve on its own.  The other option that you doctor has is to aspirate the cyst before the cycle begins.  He could relook with the ultrasound before the IVF cycle is supposed to start and if the cyst is present, he can aspirate it vaginally using the same technique used for egg retrieval.  Then you will be able to proceed with the cycle.  If the cyst is present and it is producing estrogen, you cannot start a stimulation cycle without resolving this.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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