Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: A retrospective cross-sectional study

Abbas Aflatoonian, Aflatoonian A, Nasim Tabibnejad, Tabibnejad N
International journal of reproductive biomedicine · 2020 · vol. 18(11) , pp. 935–942 · doi:10.18502/ijrm.v13i11.7960 · PMID:33349801 · PMC7749973 · W3107671765
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This study found that both aspiration and retention of ethanol after sclerotherapy for ovarian endometrioma yielded similar pregnancy and recurrence rates in infertile women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This retrospective study of 43 women with postsurgical recurrent or bilateral ovarian endometrioma evaluated whether the exposure time of 95% ethanol during transvaginal ultrasound-guided sclerotherapy affects recurrence and pregnancy outcomes, comparing an aspiration/irrigation after 10 minutes of ethanol versus leaving ethanol in situ for the same total exposure period. Women were followed for 3, 6, and 12 months for natural or assisted conception, with recurrence defined as cyst diameter >3 cm, and cytology of aspirated fluid checked for atypical cells. The aspiration and retention groups had similar chemical pregnancy, ongoing pregnancy, live birth, and recurrence rates (p=0.500), and no atypical cells were detected; however, in the retention group cyst size significantly correlated with recurrence, with cysts >5 cm recurring more often. The paper’s main limitation is its retrospective, non-randomized surgeon-assigned group allocation and attrition due to loss to follow-up. This paper is centrally about endometriosis — specifically comparing aspiration versus ethanol retention strategies for treating ovarian endometrioma.

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Abstract

BACKGROUND: Endometrioma is a common high-recurrence gynecological disease that affects infertility. Surgical resection using laparotomy or laparoscopy is applied as a standard treatment. Moreover, sclerotherapy is reported to be effective as a non-invasive method for treating endometrioma. OBJECTIVE: To evaluate whether the ethanol retention or aspiration after sclerotherapy improve pregnancy outcome in infertile women with endometrioma. MATERIALS AND METHODS: In a retrospective study, hospital records of 43 women with recurrent or bilateral endometrioma who had been undergone transvaginal ultrasound sclerotherapy were reviewed. They were selected to receive either ethanol for 10 min, ethanol injection, irrigation, and then aspiration or total retention without aspiration based on the surgeon's decision. The participants were followed-up for 3, 6 and 12 months for natural or artificial conception as well as for cyst recurrence. RESULTS: Chemical pregnancy was positive in 52% of the women in the aspiration group and 53.8% in the retention group. Ongoing pregnancy (44% vs 46.2%, p = 0.584) and live birth (40% vs 46.2%, p = 0.490) were reported marginally higher in the retention group compared with the aspiration group, and the differences were not statistically significant. Moreover, the recurrence rate were found to be 48.1% and 37.5% in the aspiration and retention groups, respectively (p = 0.542). The cysts size in the retention group was significantly correlated to the recurrence rate. CONCLUSION: Both the aspiration and left in situ of ethanol 95% sclerotherapy have the similar impact on the treatment of ovarian endometrioma regarding pregnancy and recurrence rate. However, larger randomized studies with strict inclusion criteria are needed.
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In conclusion, our result showed that sclerotherapy using both aspiration and left in situ of ethanol 95% have a similar impact on the treatment of ovarian endometrioma regarding the pregnancy and recurrence rates. However, larger randomized studies with strict inclusion criteria are necessary to evaluate the effect of endometrioma sclerotherapy on bilateral cyst and improvement of ART outcome.

Coi Statement

The authors declare that there is no conflict of interest.

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endometriomainfertility

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