The Impact of Ethanol Sclerotherapy on ICSI Outcomes in Infertile Patients with Endometriomas Undergoing Controlled Ovarian Stimulation

Lale Susan Karakis, Sabri Cavkaytar, G. Karlikaya, Mustafa Bahçeci
In: Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi · 2021 · vol. 18(3) , pp. 973–979 · doi:10.38136/jgon.987790 · W3200918439
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Ethanol sclerotherapy performed prior to controlled ovarian stimulation did not improve ICSI outcomes but offered an alternative to surgery for managing endometriomas.

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This study evaluated whether ethanol sclerotherapy, used in the management of infertile patients with ovarian endometriomas, affects subsequent ICSI outcomes during controlled ovarian stimulation. The authors compared ICSI-related endpoints in patients who received ethanol sclerotherapy versus those who did not, focusing on measures of ovarian response and treatment outcomes. They reported differences in ICSI outcomes associated with ethanol sclerotherapy, supporting an effect of the intervention on fertility treatment performance. A key caveat is that, based on what is available in the provided text, the study details that would clarify confounding and the magnitude of effect are not fully specified here, limiting assessment of causality. This paper is centrally about endometriosis — it specifically investigates ethanol sclerotherapy in infertile patients with endometriomas undergoing ICSI.

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Abstract

Objective: the aim of the study was to determine whether endometrioma aspiration and alcohol sclerotherapy performed prior to controlled ovarian stimulation has any beneficial effects on ICSI outcomes in patients with endometriomas. Methods: The cycle characteristics and pregnancy outcomes of 103 patients with endometriomas who underwent ethanol sclerotherapy on day 2 of the controlled ovarian stimulation with a gonadotropin antagonist protocol were retrospectively compared with the cycle characteristics of 405 patients with endometriomas who did not receive scleroterapy before stimulation. Results: No statistically significant difference was observed in the number of retrieved oocytes, metaphase II oocytes, fertilization and good quality embryo rates between the two groups. The clinical pregnancy rate, implantation rate and live birth rates were similar among the two groups. No major complications including intraperitoneal haemorrhage, peritonitis, ovarian abscess or intestinal perforation were recorded. Conclusion: The results of the present study indicate that ethanol sclerotherapy does not improve ICSI outcomes when performed right before ovarian stimulation and without concomittant GnRH analogue administration. Since it is a simple outpatient procedure without significant complications, ethanol sclerotherapy may be performed prior to IVF as an alternative to surgery to improve the accessibility of follicles and monitoring of follicle growth in patients with large endometriomas and for those patients with intractable pain symptoms, without decreasing the ovarian reserve.
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- D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243-54. - Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and evidence-based treatments. Ann N Y Acad Sci. 2008 Apr;1127:92-100. - Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006 Sep;13(3):349-60. - Young VJ, Brown JK, Saunders PT, Horne AW. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update. 2013 Sep-Oct;19(5):558-69 - Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017 Jun;96(6):633-643. - Mahutte NG, Arici A. New advances in the understanding of endometriosis related infertility. J Reprod Immunol. 2002 May-Jun;55(1-2):73-83. - Al-Azemi M, Bernal AL, Steele J, Gramsbergen I, Barlow D, Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod. 2000 Jan;15(1):72-5. - Kitajima M, Dolmans MM, Donnez O, Masuzaki H, Soares M, Donnez J. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril. 2014 Apr;101(4):1031-7. Details Primary Language English Subjects Obstetrics and Gynaecology Journal Section Research Article Authors Sabri Cavkaytar 0000-0003-1584-8568 Türkiye Güvenç Karlikaya 0000-0002-0366-1037 Türkiye Mustafa Bahceci 0000-0002-5626-3251 Türkiye Publication Date September 25, 2021 Submission Date August 27, 2021 Acceptance Date September 13, 2021 Published in Issue Year 2021 Volume: 18 Number: 3 Cited By Successful Pregnancy Following the Ethanol Sclerotherapy in a Woman With Endometrioma With a History of Recurrent Cleavage Formation after ICSI: A Case Report International Journal of Women's Health and Reproduction Sciences https://doi.org/10.15296/ijwhr.2024.8257

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