Ultrasound-based decision-making for minimally invasive sclerotherapy of ovarian endometrioma

Ovarian endometrioma (OEM) remains a challenging manifestation of endometriosis, particularly in women with infertility, recurrent disease, or concern about ovarian reserve. Ultrasound-guided sclerotherapy has emerged as a minimally invasive treatment option in selected patients, but its appropriate use depends heavily on imaging-based decision-making. This review examines the role of ultrasound across the care pathway of sclerotherapy for OEM, with emphasis on diagnosis, risk stratification, patient selection, procedural planning, treatment guidance, and post-treatment surveillance. English-language literature up to May 2026 was searched in PubMed, Embase, Web of Science, and Scopus using terms related to OEM, endometriosis, transvaginal ultrasound, ultrasound-guided aspiration, sclerotherapy, ethanol sclerotherapy, recurrence, ovarian reserve, infertility, and assisted reproduction. Current evidence indicates that transvaginal ultrasound is central not only to confirming the diagnosis of OEM, but also to excluding mimickers and malignant red flags before intervention. In women considered for sclerotherapy, ultrasound provides key information on lesion morphology, disease extent, ovarian mobility, pelvic adhesions, accessibility, and puncture safety. Ultrasound-guided sclerotherapy appears to be a feasible minimally invasive option in selected women, particularly when preservation of ovarian reserve is prioritized. However, the available literature remains heterogeneous with regard to patient selection, procedural protocols, sclerosant exposure, definitions of response and recurrence, and follow-up intervals. Ultrasound may therefore play an important role not only in procedural guidance, but also in decision-making throughout the care pathway of OEM sclerotherapy. A standardized ultrasound-based framework may improve candidate selection, procedural consistency, and post-treatment surveillance, and may help better define the role of sclerotherapy in clinical practice. Abbreviations - OEM: - Ovarian endometrioma - TVUS: - Transvaginal ultrasound - DE: - Deep endometriosis - TOA: - Tubo-ovarian abscess - MRI: - Magnetic resonance imaging - ART: - Assisted reproductive technology - IVF: - In vitro fertilization - ICSI: - Intracytoplasmic sperm injection - AMH: - Anti-Müllerian hormone - AFC: - Antral follicle count - IOTA: - International Ovarian Tumor Analysis - IDEA: - International Deep Endometriosis Analysis

We would like to express our gratitude to Professor Guonan Zhang from the Department of Gynecologic Oncology and Professor Man Lu from the Department of Ultrasound at the Sichuan Clinical Research Center for Cancer for their valuable guidance and helpful revisions of the article. Clinical trial number Not applicable. Funding This work has received support from the National Natural Science Foundation of China (grant number 81902670), the Key Research and Development Program of Sichuan Provincial Science and Technology Department (grant numbers 2019YFS0424 and 2023YFS0093), China Postdoctoral Science Foundation (grant number 2023M730510). Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Zhu, Y., Mo, Y., Zhang, J. et al. Ultrasound-based decision-making for minimally invasive sclerotherapy of ovarian endometrioma. J Ovarian Res (2026). https://doi.org/10.1186/s13048-026-02257-w Received: Accepted: Published: DOI: https://doi.org/10.1186/s13048-026-02257-w