Safety and Efficacy of Laparoscopic Versus Transvaginal Ethanol Sclerotherapy for Ovarian Endometriomas: A Preliminary Study

STUDY OBJECTIVE: To compare the safety and efficacy of laparoscopic versus transvaginal ethanol sclerotherapy in patients with ovarian endometriomas (OEMs). DESIGN: Preliminary retrospective cohort study. SETTING: Reproductive Medicine Research Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, China & Fertility Center, Shenzhen Hengsheng Hospital, Shenzhen, Guangdong, China. INTERVENTION: Laparoscopic ethanol sclerotherapy or transvaginal ethanol sclerotherapy. MEASUREMENTS AND MAIN RESULTS: From June 2019 to June 2024, 124 patients with OEMs were divided into 2 groups: transvaginal (n = 62) and laparoscopic (n = 62) ethanol sclerotherapy. After 1:1 propensity score matching, 42 patients remained in each group with balanced baseline characteristics. All returned for controlled ovarian hyperstimulation (COH) 2 months postoperatively. No severe complications occurred. The laparoscopic group showed a significantly less decline in AMH (-0.18 vs -0.27 ng/mL, p = .042). The number of oocytes retrieved was similar (9.5 vs 9.5, p = .890). Fertilization rate (75.4% vs 64.7%, p <.001) and high-quality D3 embryo formation rate (60.6% vs 45.4%, p <.001) were significantly higher in the laparoscopic group, with D3 embryo formation rate marginally higher (80.4% vs 73.9%, p = .057). Blastocyst development and rate of no embryo availability did not differ. After adjustment, biochemical pregnancy rate (77.5% vs 64.3%, OR = 1.304, 95% CI: 0.434-3.936, p = .634), clinical pregnancy rate (57.5% vs 59.5%, OR = 0.885, 95% CI: 0.321-2.437, p = .813), and live birth rate (52.5% vs 57.1%, OR = 0.954, 95% CI: 0.348-2.615, p = .927) showed no significant difference. CONCLUSION: Both transvaginal and laparoscopic ethanol sclerotherapy were safe options for treating OEMs. But laparoscopic surgery proved better preserve ovarian reserve and improve embryo development. TRIAL REGISTRATION: Not applicable.