Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis

Objective Catheter-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.

Retrospective, 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.

A 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.

The 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. Clinical relevance statement Catheter-directed ethanol sclerotherapy for patients with recurrent endometrioma has similar effect on ovarian reserve compared to patients with primary endometrioma. Key Points • Secondary surgery for endometrioma has significant deleterious effect on ovarian function. • 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. • Physicians should consider CDS for patients with recurrent endometrioma who desire to preserve ovarian function. Similar content being viewed by others Abbreviations - AFC: - Antral follicle count - AMH: - Anti-Müllerian hormone - BMI: - Body mass index - CA-125: - Cancer antigen 125 - CDS: - Catheter-directed sclerotherapy - FSH: - Follicle-stimulating hormone - IQR: - Interquartile range - PCOS: - Polycystic ovarian syndrome - PSM: - Propensity score matching

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Fertil Steril 110(6):1173–1180 Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (NRF-2020R1C1C1013849). This study was also supported by a CMB-Yuhan research grant of Yonsei University College of Medicine (6–2018-0173). Author information Authors and Affiliations Corresponding authors Ethics declarations Guarantor The scientific guarantor of this publication is Seok Kyo Seo. Conflict of interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry One of the authors has significant statistical expertise (Hae-Rim Kim). Informed consent Written informed consent was waived by the Institutional Review Board, owing to the retrospective nature of the study. Ethical approval Approval was obtained from the Institutional Review Board of the Severance Hospital, Yonsei University College of Medicine (approval no. 4–2021-1793). Study subjects or cohorts overlap Fifty-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. Methodology • retrospective • observational • performed at one institution Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer 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. About this article Cite this article Lee, 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 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00330-023-10320-z