Sclerotherapy with ethanol: An effective and safe alternative to potentially complex surgical treatment of recurrent ovarian endometrioma

Abstract

Objective: The aim of this study was to evaluate the efficacy and safety of transvaginal ultrasound guided aspiration of ovarian endometrioma and ethanol sclerotherapy before controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) or assisted reproductive technology (ART) in patients with recurrent ovarian endometrioma. Design: Prospective study. Setting: Infertility Care and Research Center (ICRC Pvt Ltd.), Dhaka, Bangladesh. Materials and methods: Fifty-three patients with infertility and recurrent ovarian endometrioma were the target population of this study. Sclerotherapy was performed under sedation (Pethidine) or G/A (propofol) and transvaginal ultrasound guidance. An 16-guage, double-lumen needle was inserted into the endometrioma and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Ninety-five percent ethyle alcohol (ethanol) was then instilled into the cyst and kept in situ. Ultrasound was performed 6 weeks, 3, 6 and 12 months later to assess the efficacy of treatment. Controlled ovarian hyperstimulation and IUI or ART was performed according to patients’ profile and desire. Main outcome measures: Resolution and recurrence of endometrioma and pregnancy rate. Results: Thirty-nine patients had unilateral, 14 had bilateral, 36 had single and 17 had more than one cysts. Size of the cysts were 3.5 to 10 cm, average 6.75 ± 1.64 cm. Complete resolution of cyst took place in 42 (79.25%) cases. Eleven patients had persistence and refilling of cyst. Four of them needed reaspiration. No complications developed in any case. Thirty patients (52 cycles) underwent COH and IUI and 5 (16.57%) of them got pregnant. Forty-one patients underwent ART (63 cycles) and 13 (31.71%) got pregnant. Six (11.32) patients developed small cyst <3 cm within 1 year during the course of treatment. Conclusion: Sclerotherapy with 95% ethanol is a simple, effective and safe alternative to surgical intervention for treatment of recurrent ovarian endometriomas before COH and IUI or ART.