Experience of using transvaginal sclerotherapy in the treatment of ovarian endometriomas

BACKGROUND: Ethanol sclerotherapy is an effective and a safe surgical treatment method for ovarian endometrioma (OMA). Destruction with 95% ethanol solution of the capsule allows minimal impact on the ovarian reserve. However, this method should be thoroughly evaluated for the possibility to be used more frequently in practice. AIM: To determine the indications for the use of transvaginal sclerotherapy in surgical treatment of OMA. MATERIAL AND METHODS: Between October 2021 and October 2023, 17 patients with OMA were operated at the Moscow Regional Research Institute of Obstetrics and Gynecology, with sclerotherapy performed by transvaginal access. Clinical manifestations included pelvic pain (76.4%), dysmenorrhea (82.3%), dyspareunia (47.0%), bowel symptoms (35.3%), polymenorrhea (47.0%), and infertility (64.7%). Eleven (64.7%) of the patients had been previously operated because of ОМА. RESULTS: Postoperative anti-Mullerian hormone (AMH) levels were slightly reduced (mean difference before and after the surgery was 0.47 ng/ml). The mean antral follicle count in the both ovaries were 10.8 before surgery and 8.6 after surgery. The volume of the ovary decreased from 2 to 6 times after sclerotherapy of the endometrioma. Symptoms recurred in four women. Six (35.2%) recurrences of endometrioma were noted with ultrasound control after 3, 6, and 12 months postoperatively. Endometrioid detritus in the cyst capsule was not detected in 64.8% of cases. CONCLUSION: Preliminary results indicates the use of sclerotherapy by transvaginal access with ultrasound control for the treatment of endometriomas in women of reproductive age and patients planning pregnancy by ART with any level of ovarian reserve and recurrent, previously histologically confirmed, symptomatic endometriomas in women of reproductive age with no plans for pregnancy presently with a reduced ovarian reserve (AMH 1.2 ng/ml) and with any level of ovarian reserve but with symptomatic endometrioma in the preserved ovary. Transvaginal access is applicable for symptomatic endometriomas in women who had undergone several operations in the past.