Assessing the efficacy of aspiration and ethanol injection in recurrent\nendometrioma before IVF cycle: A randomized clinical trial

Background: Endometriosis is a common hormone-dependent gynecologic\ndisease with a high recurrence. Laparotomy or laparoscopy is the\nstandard surgery for the large endometrioma. Also, sclerotherapy is\nbasically used to treat different diseases one of which is\nendometrioma. Objective: The study was designed to assess the value of\ntransvaginal ultrasound-guided ethanol sclerotherapy in patients with a\nrecurrent endometrioma. Materials and Methods: In a randomized clinical\ntrial, an interventional group of 20 patients underwent transvaginal\nethanol sclerotherapy for recurrent ovarian endometrioma. The patients\nwere followed up first after one and two weeks and then after one, two,\nand three months. If the patients had no endometrioma, they were\ntreated with in vitro fertilization (IVF) (standard long protocol). A\ncontrol group of 20 patients with endometrioma were enrolled for an IVF\nprotocol. They had no treatment by ethanol sclerotherapy. IVF\nparameters, pregnancy rates, and implantation rates were compared in\nboth groups. Results: The demographic data showed no difference between\nthe two groups. The initial mean endometria size was 41.45±15.9\ncm, the recurrence rate after 6 months was 4 (20%), FSH before and\nafter sclerotherapy was 6.97±2.25 IU/L and 6.78±1.88 IU/L\n(p=0.343). The clinical pregnancy rate was 6 (33.3%) vs. 3 (15%),\n(p=0.616). The fertilization rate emerged 63.06% in study group vs.\n60.38%, (p=0.57). The implantation rate turned out 12.9% in study group\nvs. 7.5%, (p=0.52). None of these results were significant. However,\nthe data pointed to a better trend toward the ethanol sclerotherapy\ngroup. Conclusion: Ethanol sclerotherapy could be an effective strategy\nfor the treatment of recurrent endometrioma especially before IVF.