{"paper_id":"05f6646b-d716-4ddf-8f61-0f34dae0781b","body_text":"Abstract\nObjective\nCatheter-directed ethanol sclerotherapy (CDS) is known to less affect the ovarian function, with comparable efficacy. This study aims to investigate the change in ovarian reserve after catheter-directed ethanol sclerotherapy in patients with recurrent endometrioma, as compared to primary endometrioma.\nMaterials and methods\nRetrospective, observational study. Electronic medical records and images of patients with endometrioma who underwent CDS from August 2014 to April 2022 at a single institution were obtained. Patients aged > 18 years old and with anti-Müllerian hormone (AMH) level between 0.8 and 10.0 with regular menstruation were enrolled. Cyst diameter, laterality, AMH level, and CA-125 level before and after 1 month, 6 months, 1 year, 2 years, and 3 years of sclerotherapy were obtained.\nResults\nA total of 180 patients were fit for analysis. There was no statistical difference in age and cyst size between the two groups. Mean values of AMH in each group were 3.35 in the primary group and 3.00 in the recurrent group prior to the procedure (p = 0.347). There was no significant difference in delta value of AMH after sclerotherapy in both groups at each follow-up period. Also, this result was consistent when stratified by laterality, preprocedural AMH level, and initial size of endometrioma. No case of recurrence was reported in both groups.\nConclusions\nThe effect of CDS on ovarian reserve is not inferior in recurrent endometrioma compared to primary endometrioma. Since sclerotherapy is known to less deteriorate the ovarian function than surgical removal of endometrioma, clinician could consider this as the first-line therapy in patients with recurrent endometrioma.\nClinical relevance statement\nCatheter-directed ethanol sclerotherapy for patients with recurrent endometrioma has similar effect on ovarian reserve compared to patients with primary endometrioma.\nKey Points\n• Secondary surgery for endometrioma has significant deleterious effect on ovarian function.\n• Catheter-directed sclerotherapy (CDS) for endometrioma had equally minimal adverse effect on ovarian reserve, represented as anti-Müllerian hormone (AMH), in both primary and recurrent groups.\n• Physicians should consider CDS for patients with recurrent endometrioma who desire to preserve ovarian function.\nSimilar content being viewed by others\nAbbreviations\n- AFC:\n-\nAntral follicle count\n- AMH:\n-\nAnti-Müllerian hormone\n- BMI:\n-\nBody mass index\n- CA-125:\n-\nCancer antigen 125\n- CDS:\n-\nCatheter-directed sclerotherapy\n- FSH:\n-\nFollicle-stimulating hormone\n- IQR:\n-\nInterquartile range\n- PCOS:\n-\nPolycystic ovarian syndrome\n- PSM:\n-\nPropensity score matching\nReferences\nZondervan KT, Becker CM, Missmer SA (2020) Endometriosis. 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This study was also supported by a CMB-Yuhan research grant of Yonsei University College of Medicine (6–2018-0173).\nAuthor information\nAuthors and Affiliations\nCorresponding authors\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Seok Kyo Seo.\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nStatistics and biometry\nOne of the authors has significant statistical expertise (Hae-Rim Kim).\nInformed consent\nWritten informed consent was waived by the Institutional Review Board, owing to the retrospective nature of the study.\nEthical approval\nApproval was obtained from the Institutional Review Board of the Severance Hospital, Yonsei University College of Medicine (approval no. 4–2021-1793).\nStudy subjects or cohorts overlap\nFifty-six of 180 patients who had undergone CDS have been previously reported [10]. The prior study was a study focused on patients at risk for decreased ovarian reserve, whereas in this manuscript, we compared effect of CDS on AMH between the primary group and recurrent group.\nMethodology\n• retrospective\n• observational\n• performed at one institution\nAdditional information\nPublisher's note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nLee, J.K., Han, K., Choi, E. et al. Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis. Eur Radiol 34, 3298–3308 (2024). https://doi.org/10.1007/s00330-023-10320-z\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-023-10320-z","source_license":"CC0","license_restricted":false}