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This prospective and retrospective single-center observational study evaluated short- and long-term outcomes of ethanol sclerotherapy in 232 reproductive-aged patients (18–39 years) with bilateral ovarian endometriomas, using transvaginal ultrasound (including antral follicle count) and serum anti-Müllerian hormone during follow-up up to 12 months. The study found no significant decrease in ovarian reserve after sclerotherapy; recurrence rates were 4.8% at 3 months and 8.4% at 12 months in the main group, with lower recurrence in patients with unilateral disease history of cystectomy, while larger tumors required additional procedures. Reproductive outcomes were assessed in 38 women planning pregnancy: after antirecurrence hormone therapy, 71.1% achieved pregnancy and live births occurred in 65.8%, with miscarriages reported before 5 weeks in 34.2%. This paper is centrally about endometriosis — specifically, it studies ethanol sclerotherapy outcomes for ovarian endometriomas (a form of endometriosis).
Abstract
In recent years, scientists around the world have focused their attention on studying the efficacy and outcomes of ethanol sclerotherapy in reproductive-aged patients with ovarian endometriomas (OEs). Today, sclerotherapy for OEs is recognized as the most optimal method for preserving ovarian reserve. Objective. To analyze the short- and long-term outcomes of ethanol sclerotherapy for OEs in reproductive-aged patients. Patients and methods. Design: This was a prospective and retrospective single-center observational study. The study enrolled 232 patients aged 18 to 39 years (26.2 ± 2.3) with OEs who underwent ethanol sclerotherapy for neoplasms between 2012 and 2025. All patients were divided into two groups depending on the size of OEs. In group 1 (n = 226), the maximum diameter of OEs did not exceed 62 mm (44.8 ± 3.9); in group 2 (n = 6), it ranged from 80 to 100 mm. In all cases, OEs were bilateral, and the age of patients ranged between 22 and 28 years. These patients were not previously pregnant. Instrumental and laboratory diagnostic methods included transvaginal ultrasound with measuring the antral follicle count and serum anti-Müllerian hormone testing. The prospective follow-up period was 12 months. Results. In none of the cases was there a significant decrease in ovarian reserve after sclerotherapy for OEs. The number of recurrences in group 1 was 11 (4.8%) and 19 (8.4%) after 3 and 12 months of follow-up, respectively. The most favorable outcomes for this parameter were observed in patients with unilateral neoplasms and a history of cystectomy: after 3 months of follow-up, no recurrences of OEs were recorded, and after 12 months, there were only 3 out of 56 (5.2%). The reproductive outcomes of sclerotherapy were studied in 38 women in group 1 who were planning a pregnancy. After a course of antirecurrence hormone therapy, 27 (71.1%) women became pregnant, of whom 15 (55.5%) participated in assisted reproductive technology programs. Live births occurred in 25 of 38 (65.8%) cases. The remaining 13 (34.2%) women had miscarriage before 5 weeks of gestation. Patients in group 2 required two (n = 2) and three (n = 4) sclerotherapy procedures to achieve complete regression of neoplasms. They did not plan to become pregnant. Conclusion. Ethanol sclerotherapy for OEs is the optimal treatment method in reproductive-aged patients, especially those with reduced ovarian reserve, as it does not damage the ovarian follicular apparatus. Recurrences of OEs after sclerotherapy should be considered not as a classic exacerbation, but as a factor potentially indicating a possible stage of sclerosis. Key words: ovarian endometrioma, ethanol sclerotherapy, ovarian reserve, recurrence, reproductive outcomes
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Long-term outcomes of ethanol sclerotherapy for ovarian endometriomas
Aleksandr I. Davydov /
Mari B. Giorgadze /
Raisa A. Chilova /
Marina B. Khabarova /
In recent years, scientists around the world have focused their attention on studying the efficacy and outcomes of ethanol sclerotherapy in reproductive-aged patients with ovarian endometriomas (OEs). Today, sclerotherapy for OEs is recognized as the most optimal method for preserving ovarian reserve.
Objective. To analyze the short- and long-term outcomes of ethanol sclerotherapy for OEs in reproductive-aged patients.
Patients and methods. Design: This was a prospective and retrospective single-center observational study. The study enrolled 232 patients aged 18 to 39 years (26.2 ± 2.3) with OEs who underwent ethanol sclerotherapy for neoplasms between 2012 and 2025. All patients were divided into two groups depending on the size of OEs. In group 1 (n = 226), the maximum diameter of OEs did not exceed 62 mm (44.8 ± 3.9); in group 2 (n = 6), it ranged from 80 to 100 mm. In all cases, OEs were bilateral, and the age of patients ranged between 22 and 28 years. These patients were not previously pregnant. Instrumental and laboratory diagnostic methods included transvaginal ultrasound with measuring the antral follicle count and serum anti-Müllerian hormone testing. The prospective follow-up period was 12 months.
Results. In none of the cases was there a significant decrease in ovarian reserve after sclerotherapy for OEs. The number of recurrences in group 1 was 11 (4.8%) and 19 (8.4%) after 3 and 12 months of follow-up, respectively. The most favorable
outcomes for this parameter were observed in patients with unilateral neoplasms and a history of cystectomy: after 3 months of follow-up, no recurrences of OEs were recorded, and after 12 months, there were only 3 out of 56 (5.2%). The reproductive outcomes of sclerotherapy were studied in 38 women in group 1 who were planning a pregnancy. After a course of antirecurrence hormone therapy, 27 (71.1%) women became pregnant, of whom 15 (55.5%) participated in assisted reproductive technology programs. Live births occurred in 25 of 38 (65.8%) cases. The remaining 13 (34.2%) women had miscarriage before 5 weeks of gestation. Patients in group 2 required two (n = 2) and three (n = 4) sclerotherapy procedures to achieve complete regression of neoplasms. They did not plan to become pregnant.
Conclusion. Ethanol sclerotherapy for OEs is the optimal treatment method in reproductive-aged patients, especially those with reduced ovarian reserve, as it does not damage the ovarian follicular apparatus. Recurrences of OEs after sclerotherapy should be considered not as a classic exacerbation, but as a factor potentially indicating a possible stage of sclerosis.
Key words: ovarian endometrioma, ethanol sclerotherapy, ovarian reserve, recurrence, reproductive outcomes
For citation: Davydov A.I., Giorgadze M.B., Chilova R.A., Khabarova M.B. Long-term outcomes of ethanol sclerotherapy for ovarian endometriomas. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2025; 24(5): 52–59. (In Russian). DOI: 10.20953/1726-1678-2025-5-52-59
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