I have a dermoid cyst. Is it safe for me to try to conceive?

Question

Hello doctor,

I was recently diagnosed with a dermoid cyst around 1.5 inches with a CA-125 level of 77. I was then put on birth control for three months.

After three months, the cyst did not increase or decrease in size. However, my CA-125 did increase from 77 to 151.8. Should I be worried? Could it be endometriosis? Is my CA-125 level supposed to increase so much with a dermoid cyst?

I am actively trying to conceive, and my FSH, LH, and progesterone levels are normal.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

So, looking at your report, CA (cancer antigen)-125 has definitely gone up from 77 to 151.8, while the cyst size has stayed stable. It is important to know that CA-125 is not a cancer-specific marker in young women. It can fluctuate a lot in benign conditions like endometriosis, pelvic inflammation, even during periods or with ovarian cysts (including dermoids) or irritation around the cyst.

A dermoid itself usually does not push CA-125 very high, but if there is some endometriotic component or pelvic irritation, it can climb.

So, I suggest you do the following tests -

Transvaginal ultrasound with Doppler (to reassess the morphology of the cyst).
MRI (magnetic resonance imaging) of the pelvis if ultrasound shows anything atypical.
Repeat CA-125 after period (levels sometimes peak mid-cycle).
Consider the AMH (anti-Müllerian hormone) test since you are planning a pregnancy.

From your descriptions, the probable diagnosis includes a benign ovarian cyst (dermoid versus endometriosis). However, we need to consider the other possibilities, which include endometrioma, functional cyst, and a less likely malignant epithelial tumor (given stable size, age, and no alarming scan features).

Treatment plan includes -

Since the cyst is stable at 1.5 inches, observation is fine if no severe symptoms are present.
If CA-125 continues rising or imaging shows suspicious features, laparoscopy for cyst removal can be considered, especially as you want to conceive.
Surgery should be fertility-sparing.
Avoid repeated CA-125 testing unless guided by imaging, as numbers alone can be misleading.

Share the detailed ultrasound or MRI report. If you notice worsening pain, irregular bleeding, or a sudden increase in cyst size, follow up sooner. Also, follow up with a fertility specialist alongside the gynecologist so you do not lose time while trying to conceive.

The fact that the cyst has not grown is a reassuring point. Since you are trying to conceive, we need to balance fertility goals with surgical decisions.

Preventive measures include tracking your cycles, avoiding delaying pregnancy planning if you are keen, maintaining a healthy weight, and following up with imaging as advised.

I hope this helps.

Thank you and take care.

Regards.