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Fetal ovarian cysts are an increasingly common finding during routine prenatal ultrasonography (US). These lesions were occasionally diagnosed in the past, but only on the basis of a palpable abdominal mass or, rarely, because a twisted ovarian cyst caused an acute abdomen. Surgery is currently recommended for neonates after prenatal diagnosis, even in asymptomatic cases, when the cyst has a diameter larger than 5 cm or echographic findings suggest torsion or intracystic hemorrhage. In our 12 cases of suspected fetal ovarian cysts, wide variations in diameter were seen in 6 during pre- and postnatal follow-up. Two of these were not confirmed at birth; 7 were treated conservatively and excluding 1 perinatal death from multiple associated anomalies and 1 case lost to follow-up, the remaining cases showed uneventful, spontaneous regression of the cyst. Postnatal US signs suggesting necrosis secondary to torsion in a previously uncomplicated cyst and requiring surgery were seen in only 3 cases. Conservative treatment must be recommended in most prenatally diagnosed cysts; indications for surgery cannot be based only on dimensions. The incidence of complications has been overemphasized and the risk of associated malignancy is negligible in newborns, while possible size reduction and resorption can be expected in most cases. Nonoperative management may also be recommended when signs of torsion are seen before birth and spontaneous asymptomatic involution of the cystic ovary is documented in early postnatal life. Accurate clinical and US follow-up is mandatory in all cases. Surgery must be reserved for symptomatic cases or when an alteration of the cystic structure is documented by US in a previously uncomplicated cyst.