Effect of Baseline Simple Ovarian Cyst on Ovulation Induction/Intrauterine Insemination Cycle Outcomes

INTRODUCTION: A simple ovarian cyst at baseline ultrasound for ovulation induction/intrauterine insemination (OI/IUI) is a finding of unclear clinical significance, and its effect on achieving pregnancy remains undetermined. Establishing the effects of a baseline ovarian cyst(s) is necessary to optimize OI/IUI cycle outcomes. METHODS: A retrospective cohort analysis of OI/IUI cycles from 2011-2021 at the UC Health Center for Reproductive Health was performed with institutional review board approval. The exposure variable was a simple appearing ovarian cyst(s) diagnosed at baseline ultrasound measuring >10 mm with estradiol level <75 ng/ml. The primary outcome analyzed was an ultrasound-confirmed intrauterine pregnancy. Secondary outcomes included positive pregnancy test and live birth. STATA was used to perform unpaired t-tests for continuous variables, Chi-square tests for dichotomous variables and a generalized linear model for regression analysis. RESULTS: A total of 161 cycles with inactive cysts were compared to 300 control cycles. Polycystic ovarian syndrome was more common in the control group and diminished ovarian reserve was more common in the baseline cyst group. Other specific diagnoses were similar between groups. The clinical pregnancy rate was higher in cycles without a baseline cyst compared to those with a cyst present, (15% vs. 9.3%, RR 0.63 [0.36–1.1]). After adjusting for body mass index and age, cycles with baseline cyst(s) were 35% less likely to result in a clinical pregnancy (adjusted RR=0.65 [0.37–1.1]). CONCLUSION: A baseline ovarian cyst is associated with a lower clinical pregnancy rate in OI/IUI cycles. This finding is clinically significant and patients should be counseled accordingly.