Chocolate Cyst

I am a 26 year old married woman and my doctor informed me that I have a chocolate cyst in my left ovary. What is a chocolate cyst? How do you treat one and would it affect my chances of getting pregnant in the future?

A ‘Chocolate cyst’, ‘endometrial cyst’ or ‘endometrioma’ are cysts caused by a condition called Endometriosis. The cyst occurs when the membrane that forms the inner layer of the uterus invades the ovary. These tissues are responsive to the hormonal changes that occur during the menstrual cycle, causing bleeding to occur within the ovary. This old blood has the appearance of melted chocolate hence the name ‘chocolate cyst’. With each menstrual cycle more bleeding occurs due to which these cysts are slow growing. Although these cysts are often asymptomatic, they can be painful, especially during your period or during intercourse.

Surgical removal by laparoscopy or ‘key hole’ surgery, is the only effective treatment. Conservative surgery can be performed in patients wanting to preserve their fertility. Medicines may also be considered prior to definite surgical management to try to reduce the size of the cysts.

This condition has been described as one of the causes of infertility. It impairs fertility by distorting the normal anatomy of the pelvic organs. Adhesions caused by this condition may interfere with the release of the eggs from the ovary or pick-up of the egg by the fallopian tubes. Even if there are no adhesions chocolate cysts may impair fertility as they decrease the egg quality and they release chemical which can hamper with the release of the eggs, entry of the egg into the tubes or with fertilization of the eggs themselves. Although endometriosis is the cause of infertility in about 35% of women, some women do conceive without any trouble. Chocolate cysts are also know to increase the chances of miscarriage in untreated women, due to the chemical released which could be toxic to the baby or by affecting the mothers immune system. What one must remember is that with appropriate treatment pregnancy can certainly be achieved in women with chocolate cysts.