Is it ok to start ivf stim medication if i have a 4cm fluid-filled cyst at my baseline ultrasound?

10 mm: Simple cysts/follicles up to 10-12 mm are usually not a problem, i start patients with them all the time. What does your doctor think?

Cyst at IVF Baseline: Not uncommon to see simple cysts especially on the luteal gnrh-a protocol. If the estrogen level is low then we usually start patients. If the cyst looks unusual or has been present for over 3 months then a formal ultrasound may be helpful. If the cyst is an endometrioma then the management is a bit controversial. Most res are now doing ivf without first removing an endometrioma but best to ask.

Would not start: Studies have shown baseline ovarian cysts greater than 1cm will reduce the ovarian response to follicle development. Cyst aspiration may be of benefit prior to stimulation as long as the cyst is simple in appearance. Certainly a complex cyst needs further evaluation. If a proven endometrioma, stimulation is reasonable as this should not impact overall pregnancy and removal reduces follicles.