TRANSVAGINAL ETHANOL SCLEROTHERAPY FOR ENDOMETRIOMAS: COMPLICATIONS, EFFECT ON OVARIAN RESERVE AND RECURRENCE RATES

Abstract

Objective

Surgical excision of endometriomas, especially with repeated procedures, can compromise ovarian reserve. Transvaginal ethanol sclerotherapy has become an increasingly popular treatment for endometriomas. However, the pre- and post-operative complications of transvaginal ethanol sclerotherapy for endometriomas are not well-documented. This study aims to report and describe the failures and complications associated with transvaginal ethanol sclerotherapy.

Materials and Methods

This was a prospective cohort study conducted at Ankara University School of Medicine between January 2022 and June 2024. The study protocol was approved by the university's ethics committee, and all participants provided written informed consent for the use of their medical data. During the study period, the inclusion criteria for ethanol sclerotherapy were women presenting with at least one endometrioma larger than 30 mm in diameter and requiring treatment for pain or infertility prior to assisted reproductive therapy. All study participants underwent preoperative evaluation using the IOTA Adnex model. Recurrence was defined as an endometrioma larger than 20 mm after 3 months.

Results

A total of 48 patients underwent ethanol sclerotherapy. No major complications were observed in any patient. The mean age of the patients was 32.36 ± 4.03 years, their BMI was 25.65 ± 4.93, and their pre-procedure AMH level was 2.51 ± 1.44 ng/mL. The mean post-procedure AMH level was 2.3 ± 1.40 ng/mL, indicating a slight decrease of 0.21 ng/mL on average. The minimum and maximum differences in AMH levels were -0.82 ng/mL and 0.55 ng/mL, respectively. No significant difference was found between the pre- and post-procedure AMH means (p=0.176). A total of 5 (10.41%)minor complications were observed among the 48 patients. Alcohol leakage occurred in 2 cases. One patient experienced urticaria-like symptoms, while another reported nausea and vomiting due to alcohol intoxication. Anaphylaxis was observed in 1 patient, likely due to the administered antibiotic, and was readily managed with adrenaline, steroids, and antihistamine treatments. Mild fever was reported in 1 patient and was addressed with oral antibiotics. Additionally, 1 patient experienced abdominal pain after the procedure, which resolved within 24 hours of follow-up. After 3 months follow up only 6 (12.5%) patients had recurrence.

Conclusion

Transvaginal ethanol sclerotherapy has proven to be an effective treatment, with a minimal impact on ovarian reserve, acceptable complication rates, and recurrence rates comparable to cystectomy.