Conclusion
Sclerotherapy offers a promising approach for patients who
wish to pursue fertility, have low ovarian reserve, and are
Seminars in Interventional Radiology Vol. 40 No. 6/2023 © 2023. Thieme. All rights reserved.
Endometriosis Agnihotri et al.546
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contraindicated from or choose not to pursue more invasive
interventions. While there remains variability within studies
assessing the impact of sclerotherapy on patient outcomes,
there appears to be a growing body of literature validating its
use in the management of patients seeking treatment.
Additionally, the targeted focus on endometriomas due, in
part, to the inability of sclerotherapy to treat deep endome-
triosis hinders the generalizability of current literature
toward patients with endometriosis at large. Nonetheless,
given the promising data thus far, further evaluation of
sclerotherapy in additional subtypes of endometriosis is
warranted.
Conflict of Interest
None declared.
Acknowledgment
None.
References
1 Horne AW, Missmer SA. Pathophysiology, diagnosis, and manage-
ment of endometriosis. BMJ 2022;379:e070750
2 Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of
endometriosis: a call to action. Am J Obstet Gynecol 2019;220
(04):354.e1–354.e12
3 Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and
infertility. J Assist Reprod Genet 2010;27(08):441 –447
4 Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.
Imaging modalities for the non-invasive diagnosis of endometri-
osis. Cochrane Database Syst Rev 2016;2(02):CD009591
5 Jee BC. Efficacy of ablation and sclerotherapy for the management
of ovarian endometroma: a narrative review. Clin Exp Reprod
Med 2022;49(02):76 –86
6 Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diag-
nosis and clinical management. Curr Obstet Gynecol Rep 2017;6
(01):34–41
7 Ghiasi M, Kulkarni MT, Missmer SA. Is endometriosis more
common and more severe than it was 30 years ago? J Minim
Invasive Gynecol 2020;27(02):452 –461
8 Saavalainen L, Tikka T, But A, et al. Trends in the incidence rate,
type and treatment of surgically veri fied endometriosis - a
nationwide cohort study. Acta Obstet Gynecol Scand 2018;97
(01):59–67
9 Gylfason JT, Kristjansson KA, Sverrisdottir G, Jonsdottir K,
Rafnsson V, Geirsson RT. Pelvic endometriosis diagnosed in an
entire nation over 20 years. Am J Epidemiol 2010;172(03):
237–243
10 Gao M, Allebeck P, Mishra GD, Koupil I. Developmental origins of
endometriosis: a Swedish cohort study. J Epidemiol Community
Health 2019;73(04):353 –359
11 Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall
LM, Hunter DJ. Incidence of laparoscopically con firmed endome-
triosis by demographic, anthropometric, and lifestyle factors. Am
J Epidemiol 2004;160(08):784 –796
12 Leibson CL, Good AE, Hass SL, et al. Incidence and characterization
of diagnosed endometriosis in a geographically de fined popula-
tion. Fertil Steril 2004;82(02):314 –321
13 Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of
endometriosis: a large population-based database study from a
healthcare provider with 2 million members. BJOG 2018;125(01):
55–62
14 ACOG Committee Opinion No. 760 Summary: dysmenorrhea and
endometriosis in the adolescent. Obstet Gynecol 2018;132(06):
1517–1518
15 Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Mon-
tazeri A. Clinical diagnosis of pelvic endometriosis: a scoping
review. BMC Womens Health 2015;15:39
16 Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of
endometriosis: the role of ultrasound and magnetic resonance.
Global Radiol 2022;10:21 –39
17 Exacoustos C, Zupi E, Piccione E. Ultrasound imaging for ovarian
and deep in filtrating endometriosis. Semin Reprod Med 2017;35
(01):5–24
18 Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of
endometriosis: looking beyond the endometrioma with a dedi-
cated protocol. Radiographics 2019;39(05):1549 –1568
19 Theodoridis TD, Zepiridis L, Mikos T, et al. Comparison of diag-
nostic accuracy of transvaginal ultrasound with laparoscopy in
the management of patients with adnexal masses. Arch Gynecol
Obstet 2009;280(05):767 –773
20 Lee SY, Koo YJ, Lee DH. Classi fication of endometriosis. Yeungnam
Univ J Med 2021;38(01):10 –18
21 Schippert C, Witte Y, Bartels J, et al. Reproductive capacity and
recurrence of disease after surgery for moderate and severe
endometriosis - a retrospective single center analysis. BMC
Womens Health 2020;20(01):1 –11
22 Practice Committee of the American Society for Reproductive
Medicine. Treatment of pelvic pain associated with endometri-
osis: a committee opinion. Fertil Steril 2014;101(04):927 –935
23 Practice Committee of the American Society for Reproductive
Medicine. Endometriosis and infertility: a committee opinion.
Fertil Steril 2012;98(03):591 –598
24 Practice bulletin no. 114: management of endometriosis. Obstet
Gynecol 2010;116(01):223 –236
25 Kalaitzopoulos DR, Samartzis N, Kolovos GN, et al. Treatment of
endometriosis: a review with comparison of 8 guidelines. BMC
Womens Health 2021;21(01):397
26 Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of
endometriosis. CMAJ 2023;195(10):E363 –E371
27 Daraï E, Lesieur B, Dubernard G, Rouzier R, Bazot M, Ballester M.
Fertility after colorectal resection for endometriosis: results of a
prospective study comparing laparoscopy with open surgery.
Fertil Steril 2011;95(06):1903 –1908
28 Quevedo A, Pasic R, Connor A, Chamseddine P. Fertility sparing
endometriosis surgery: a review. Gynecol Obstet Clin Med 2021;1
(03):112–118
29 Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Cro-
signani PG. Surgery for endometriosis-associated infertility: a
pragmatic approach. Hum Reprod 2009;24(02):254 –269
30 Mavrelos D, Saridogan E. Treatment of endometriosis in women
desiring fertility. J Obstet Gynecol India 2015;65(01):11 –16
31 Dunselman GAJ, Vermeulen N, Becker C, et al; European Society of
Human Reproduction and Embryology. ESHRE guideline: man-
agement of women with endometriosis. Hum Reprod 2014;29
(03):400–412
32 Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele
L. Surgical excision of endometriomas and ovarian reserve: a
systematic review on serum antimüllerian hormone level mod-
ifications. Fertil Steril 2012;98(06):1531 –1538
33 Ghasemi Tehrani H, Tavakoli R, Hashemi M, Haghighat S. Ethanol
sclerotherapy versus laparoscopic surgery in management of
ovarian endometrioma; a randomized clinical trial. Arch Acad
Emerg Med 2022;10(01):e55
34 Koo JH, Lee I, Han K, et al. Comparison of the therapeutic ef ficacy
and ovarian reserve between catheter-directed sclerotherapy and
surgical excision for ovarian endometrioma. Eur Radiol 2021;31
(01):543–548
35 Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of
ovarian endometrioma: systematic review and meta-analysis.
Fertil Steril 2017;108(01):117 –124.e5
36 Noma J, Yoshida N. Ef ficacy of ethanol sclerotherapy for ovarian
endometriomas. Int J Gynaecol Obstet 2001;72(01):35 –39
Seminars in Interventional Radiology Vol. 40 No. 6/2023 © 2023. Thieme. All rights reserved.
Endometriosis Agnihotri et al. 547
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
37 Wang LL, Dong XQ, Shao XH, Wang SM. Ultrasound-guided
interventional therapy for recurrent ovarian chocolate cysts.
Ultrasound Med Biol 2011;37(10):1596 –1602
38 Jee BC. Efficacy of ablation and sclerotherapy for the management
of ovarian endometrioma: a narrative review. Clin Exp Reprod
Med 2022;49(02):76 –86
39 Yazbeck C, Madelenat P, Ayel JP, et al. Ethanol sclerotherapy: a
treatment option for ovarian endometriomas before ovarian
stimulation. Reprod Biomed Online 2009;19(01):121 –125
40 Alborzi S, Askary E, Keramati P, et al. Assisted reproductive
technique outcomes in patients with endometrioma undergoing
sclerotherapy vs laparoscopic cystectomy: prospective cross-
sectional study. Reprod Med Biol 2021;20(03):313 –320
41 Lee KH, Kim CH, Lee YJ, Kim SH, Chae HD, Kang BM.
Surgical resection or aspiration with ethanol sclerotherapy
of endometrioma before in vitro fertilization in infertile
women with endometrioma. Obstet Gynecol Sci 2014;57
(04):297 –303
42 Aflatoonian A, Rahmani E, Rahsepar M. Assessing the ef ficacy of
aspiration and ethanol injection in recurrent endometrioma
before IVF cycle: a randomized clinical trial. Iran J Reprod Med
2013;11(03):179–184
Seminars in Interventional Radiology Vol. 40 No. 6/2023 © 2023. Thieme. All rights reserved.
Endometriosis Agnihotri et al.548
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.