Experience of using transvaginal sclerotherapy in the treatment of ovarian endometriomas.

Abstract

Abstract Ethanol sclerotherapy is effective and safe method of surgical treatment for ovarian endometrioma. 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 - determination of indications for the use of the technique of transvaginal sclerotherapy in surgical treatment of ovarian endometriomas. Materials and methods From the October 2021 to October 2023 17 patients with ovarian endometrioma (OMA) were operated in the Moscow Regional Research Institute of Obstetrics and Gynecology with sclerotherapy perfomed 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 %). 11 (64.7%) of patients had been previously operated because of ОМА. Results Postoperative level of antimullerian hormone (AMH) were slightly reduced (mean difference before and after the surgery was -0.47 ng/ml). Mean antral follicle count (AFC) 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 returned in 4 women. There were 6 recurrences of endometrioma (35.2%) noted with ultrasound control after 3, 6 and 12 months after operation. The absence of endometrioid detritus in the cyst capsule was detected in 64.8% cases. Conclusion Preliminary results allow us to recommend the following options for the use of sclerotherapy by transvaginal access with ultrasound control: For the endometriomas in women of reproductive age and patients planning pregnancy by ART with any level of ovarian reserve. For the recurrent, previously histologically confirmed, symptomatic endometriomas in women of reproductive age with no plans for pregnancy presently with a reduced ovarian reserve (AMH1.2 ng/ml) and with any level of ovarian reserve but with symptomatic endometrioma in only preserved ovary. Transvaginal access is applicable for symptomatic endometriomas in the women with a big number of operations in the past.