With a 22mm active hormone-producing cyst and E2 of 288, most fertility specialists would prefer not to start stimulation yet. High baseline E2 interferes with follicle recruitment and can affect egg quality. The cyst typically needs to resolve on its own or be aspirated before stimulation begins.

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You can take hormonal pills as per your doctor's advice for a month to dissolve the cyst From next cycle, uou can plan ivf

Yes, stimulation may sometimes proceed, but a 22 mm hormonally active cyst with E2 288 can affect baseline follicular recruitment and response. The decision depends on the E2 unit, cycle day, ultrasound findings, ovarian reserve and IVF protocol. Many fertility specialists prefer to delay stimulation until the cyst resolves and baseline estradiol is appropriately suppressed, while in selected cases stimulation may still be started. Please discuss with your IVF specialist, as the decision should be individualized rather than based on cyst size alone.

It is always better to downregulate the cycle with ocps and then start stimulation