Abstract
Study Objective
To compare the effects of ultrasound-guided aspiration and ethanol sclerotherapy with
those of laparoscopic surgery on anti-Müllerian hormone (AMH) levels and ovarian reserve
in benign-appearing ovarian endometrioma.
Design
A prospective, cohort pilot study.
Setting
Multiple centers, Spain.
Patients
Forty patients with a suspected ovarian endometrioma with a maximum diameter of 35–100
mm. Serum hormonal concentrations were analyzed in 26 of these women.
Interventions
Two groups: one that received US-guided aspiration plus alcohol sclerotherapy (n =
16) and the other that underwent laparoscopic cystectomy (n = 10).
Measurements and Main Results
We studied serum hormonal concentrations (AMH, FSH and 17-β-estradiol) and antral
follicle counts (AFC) in each patient at baseline, and after the procedures and pregnancies.
No differences were found when comparing AMH and FSH concentrations before and after
each procedure. 17-β-estradiol concentrations were significantly increased after alcohol
sclerotherapy (p < 0.001). AFC recovery after 6 months seemed to be higher after sclerotherapy
than after surgery. Three patients became pregnant in the sclerotherapy group.
Conclusion
This pilot study indicated that alcohol sclerotherapy preserves fertility in patients
with endometriomas better than surgery, with significant increases in serum estradiol
concentrations, possible AFC recovery and spontaneous pregnancies observed in the
patients after sclerotherapy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endometriosis and infertility: epidemiology and evidence-based treatments.Ann N Y Acad Sci. 2008; 1127 (PMID: 18443335): 92-100https://doi.org/10.1196/annals.1434.007
- Ultrasound findings in infertile women with endometriosis: evidence of concomitant uterine disorders.Gynecol Endocrinol. 2020; 36: 808-812https://doi.org/10.1080/09513590.2020.1736027
- Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease.Fertil Steril. 1999; 72: 310-315https://doi.org/10.1016/s0015-0282(99)00211-3
- Treatment algorithm for women with endometriosis in a certified endometriosis unit.Minerva Ginecol. 2020; 72: 43-49https://doi.org/10.23736/S0026-4784.20.04490-1
- Excisional surgery versus ablative surgery for ovarian endometriomata: a cochrane review.Hum Reprod. 2005; 20: 3000-3007https://doi.org/10.1093/humrep/dei207
- Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?.Fertil Steril. 2002; 77: 609-614https://doi.org/10.1016/s0015-0282(01)03203-4
- The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.J Clin Endocrinol Metab. 2012; 97: 3146-3154https://doi.org/10.1210/jc.2012-1558
- Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons.Reprod Biomed Online. 2011; 23: 740-746https://doi.org/10.1016/j.rbmo.2011.07.014
- Impact of cystectomy on ovarian reserve: review of the literature.J Minim Invasive Gynecol. 2017; 24: 247-257https://doi.org/10.1016/j.jmig.2016.12.010
- Testing and interpreting measures of ovarian reserve: a committee opinion.Fertil Steril. 2015; 103: e9-e17https://doi.org/10.1016/j.fertnstert.2014.12.093
- Stable serum levels of anti-Müllerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women.Hum Reprod. 2007; 22: 1837-1840https://doi.org/10.1093/humrep/dem101
- Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve.Hum Reprod. 2002; 17: 3065-3071https://doi.org/10.1093/humrep/17.12.3065
- Production of anti-Müllerian hormone: another homology between Sertoli and granulosa cells.Endocrinology. 1984; 114: 1315-1320https://doi.org/10.1210/endo-114-4-1315
- Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study.Fertil Steril. 2005; 83: 979-987https://doi.org/10.1016/j.fertnstert.2004.11.029
- Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications.Fertil Steril. 2012; 98: 1531-1538https://doi.org/10.1016/j.fertnstert.2012.08.009
- The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis.Hum Reprod. 2014; 29: 2190-2198https://doi.org/10.1093/humrep/deu199
- Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results.Eur J Obstet Gynecol Reprod Biol. 2015; 187: 25-29https://doi.org/10.1016/j.ejogrb.2015.02.004
Akamatsu N., Hirai T., Masaoka H., Sekiba K., Fujita T. Nihon Sanka Fujinka Gakkai Zasshi. 1988;40(2):187-191.
- Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts.Radiol Med. 2010; : 1330-1339https://doi.org/10.1007/s11547-010-0586-0
- Ultrasound-guided aspiration and ethanol sclerotherapy (EST) for treatment of cyst recurrence in patients after previous endometriosis surgery: analysis of influencing factors using a decision tree.J Minim Invasive Gynecol. 2013; 20: 595-603https://doi.org/10.1016/j.jmig.2013.03.004
- Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation.Reprod Biomed Online. 2009; 19: 121-125https://doi.org/10.1016/s1472-6483(10)60055-7
- Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma.Obstet Gynecol Sci. 2014; 57: 297-303https://doi.org/10.5468/ogs.2014.57.4.297
- Ethanol sclerotherapy versus laparoscopic surgery for endometrioma treatment: a prospective, multicenter, cohort pilot study.J Minim Invasive Gynecol. 2020; 27: 1133-1140https://doi.org/10.1016/j.jmig.2019.08.036
- Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group.Ultrasound Obstet Gynecol. 2000; 16: 500-505https://doi.org/10.1046/j.1469-0705.2000.00287.x
- Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group.Ultrasound Obstet Gynecol. 2016; 48: 318-332https://doi.org/10.1002/uog.15955
- Efficacy of ethanol sclerotherapy for ovarian endometriomas.Int J Gynaecol Obstet. 2001; 72: 35-39https://doi.org/10.1016/s0020-7292(00)00307-6
- Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis.Fertil Steril. 2017; 108 (e5): 117-124https://doi.org/10.1016/j.fertnstert.2017.05.015
- Catheter-directed sclerotherapy for ovarian endometrioma: short-term outcomes.Radiology. 2018; 289: 854-859https://doi.org/10.1148/radiol.2018180606
- Serum anti-müllerian hormone levels before surgery in patients with ovarian endometriomas compared to other benign ovarian cysts.J Menopausal Med. 2015; 21: 142-148https://doi.org/10.6118/jmm.2015.21.3.142
- Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve.Int J Gynaecol Obstet. 2018; 140: 11-17https://doi.org/10.1002/ijgo.12338
- Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study.Fertil Steril. 2015; 103: 1236-1243https://doi.org/10.1016/j.fertnstert.2015.01.032
- Comparing long term impact on ovarian reserve between laparoscopic ovarian cystectomy and open laprotomy for ovarian endometrioma.J Ovarian Res. 2013; 6 (Published 2013 Nov 2): 76https://doi.org/10.1186/1757-2215-6-76
- Surgical excision of ovarian endometriomas: does it truly impair ovarian reserve? Long term anti-Müllerian hormone (AMH) changes after surgery.J Obstet Gynaecol Res. 2015; 41: 1773-1778https://doi.org/10.1111/jog.12830
- Reproductive performance after ultrasound-guided transvaginal ethanol sclerotherapy for ovarian endometriotic cysts.Eur J Obstet Gynecol Reprod Biol. 2002; 105: 39https://doi.org/10.1016/s0301-2115(02)00144-6
Article info
Publication history
Published online: January 22, 2021
Accepted:
January 16,
2021
Received in revised form:
January 9,
2021
Received:
November 21,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
