Despite an improvement in prenatal ultrasonographic diagnosis, the management of fetal ovarian cysts remains controversial. 420 fetuses with ovarian cyst from Medline data base have been analyzed. In 209 cases (50%), the cysts regressed spontaneously and in 145 cases (35%) cysts were complicated by torsion and intracystic hemorrhage. Surgical treatment was performed in 174 cases (41%) of neonates. Cysts < 50mm regressed spontaneously in 98% (n = 79), and cysts > 50mm in 93% resulted in complications (n = 14). After the diagnosis of fetal ovarian cysts < 50mm, serial ultrasound monitoring was recommended by the vast majority of the authors. In cases of > 50mm cysts, needle aspiration was an option in selected cases (n = 28). Spontaneous regression cysts > 50mm after needle aspiration was observed in 89% (n = 25) of the cases. Prenatal aspiration of ovarian cysts appears effective and safe, however, in the course of the last twenty years it has been performed relatively rarely.