Transvaginal Ethanol Sclerosis versus Saline Aspiration of Endometriomas Prior to IVF: A Randomized Controlled Trial

John C. Petrozza
In: Obstetrics & Gynecology International Journal · 2018 · vol. 9(1) · doi:10.15406/ogij.2018.09.00293 · W2785151999
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Ethanol sclerosis of recurrent endometriomas prior to IVF, compared to saline aspiration, increased peak estradiol levels and the number of oocytes retrieved.

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Abstract

Objective: Evaluate whether transvaginal aspiration of endometriomas with saline or ethanol sclerosis improves ovarian response and IVF outcomes. Design: This was a randomized controlled trial of 22 women undergoing IVF at a university-affiliated infertility clinic, 1998-2002. Subjects, aged 18-42 with body mass index (BMI, kg/m2) less than 40 and adequate ovarian reserve, had undergone laparoscopic cystectomy for an endometrioma within 12 months followed by an unsuccessful IVF cycle with recurrence on imaging. Ten subjects were randomized to cyst aspiration with saline (control) and 12 to 95% ethanol, followed by another IVF cycle. The main outcomes were ovarian response and IVF outcomes pre- and post-endometrioma aspiration. Results: There was a higher median peak estradiol level post-aspiration (2598 pg/ml vs. 2107pg/ml, p = 0.04) and a greater increase in the median number of oocytes retrieved during the post-aspiration IVF cycle compared to the pre-aspiration cycle (3 vs. 2, p = 0.04) in the ethanol versus saline group. Conclusion: Ethanol sclerosis leads to a higher peak estradiol level and a greater increase in the number of oocytes retrieved from initial to post-aspiration IVF cycle compared to saline. In women with recurrent endometriomas attempting IVF, ethanol sclerosis is a minimally invasive alternative to surgery.

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endometriomainfertility

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