In situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas: A randomized controlled trial

H. Shawki, Mahmoud Elmorsi, Ahmed Samir, Mostafa K. Eissa
In: Middle East Fertility Society Journal · 2011 · vol. 16(3) , pp. 224–231 · doi:10.1016/j.mefs.2011.02.002 · W2034589458
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This randomized controlled trial found that transvaginal ultrasound-guided aspiration followed by in situ methotrexate injection significantly improved success rates for treating ovarian endometriomas compared to aspiration alone.

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Abstract

To evaluate prospectively the efficacy and safety of in situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas in well selected patients. Randomized controlled trial. El-Menya infertility research and treatment center (MIRTC), Egypt. Two hundred and ten patients complaining of symptomatic ovarian endometriomas during reproductive age. Transvaginal ultrasound aspiration (group I) versus aspiration and in situ methotrexate injection (group II). Of 210 patients, 188 patients were available for follow-up; malignant cells were not found in any of them. The overall success rate after complete follow up was 54.73% in group I versus 86.02% in group II, among those patients 25 patients (26.3%) needed single aspiration, 14 patients (14.7%) needed two aspiration, and 13 patients (13.6%) needed three aspiration in study group I versus 62 patients (66.6%) needed single injection, 11 patients (11.8%) needed two injections and 7 patients (7.5%) needed three injections in group II which represented statistically significant difference (P < 0.05). The cyst size and volume of fluid aspirated were statistically significant factors in the resolution of the cyst (P < 0.05), while patients age was not. Transvaginal ultrasound-guided aspiration and in situ methotrexate injection is simple, safe, non-invasive and effective in the treatment of selected cases of ovarian endometriomas with much acceptability among patients.

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