Ovarian cysts are the most common abdominal cyst in the female fetus, with an incidence of 1 in 2600. Applying the IOTA terminology in such cases allows appropriate follow-up to preserve fetal ovarian function in those born with masses without signs of ovarian torsion, which is the most frequent complication. Standardising the description of ultrasonographic features allows clinicians to decide on routine follow-up or surgical intervention, ranging from cystectomy to oophorectomy in worst-case scenarios. Here, we describe three cases in which we find that the application of detailed IOTA description is associated with outcome. In addition, we assess the presence of related maternal risk factors. The generation of a common descriptive summary favours assertive communication between clinicians and surgeons and represents better reproductive outcomes for the girls evaluate. Maternal age Years