Sclerotherapy of Ovarian Endometriomas During Oocyte Preservation: A Prospective Feasibility Cohort Study.

OBJECTIVE

To evaluate the feasibility, safety, and preliminary efficacy of concurrent transvaginal ovarian puncture for oocyte retrieval and ethanol sclerotherapy of ovarian endometriomas (eSCLT) during controlled ovarian stimulation.

DESIGN

Prospective single-center pilot cohort study with a before-after design and no randomization.

SETTING

Assisted Reproductive Technology Unit of a public tertiary hospital in Spain.

PATIENTS: Twenty-three women aged 18 to 40 years seeking fertility preservation, presenting with unilateral endometrioma ≥3 cm or bilateral endometrioma with at least 1 cyst >3 cm.

INTERVENTIONS: Combined transvaginal oocyte pick-up followed by ultrasound-guided eSCLT.

MEASUREMENTS AND MAIN

RESULTS

Endometrioma volume reduction and symptomatic improvement assessed by Visual Analog Scale (VAS) pain scores and Endometriosis Health Profile-30 (EHP-30). Secondary outcomes included variations in ovarian reserve parameters (antral follicle count [AFC] and anti-Müllerian hormone [AMH] assessed before the procedure and at 3-month follow-up). Endometrioma volume showed a statistically significant reduction from a mean (SD) of 53.04 (39.34) cm3 pre-intervention to 8.32 (9.20) cm3 at 3 months (p = .002). VAS scores decreased from 7.24 (1.82) to 5.53 (2.63) (p = .037), and EHP-30 total scores improved from 78.35 (17.92) to 48.53 (18.95) (p < .001). Ovarian reserve markers remained stable (AMH: 2.50 [2.03] vs 2.37 [1.94] ng/mL, p = .82; AFC increased from 9.50 [6.16] to 14.10 [8.33] follicles, p = .03). One Clavien-Dindo Grade III complication (infection requiring surgical intervention) occurred.

CONCLUSION

This pilot study suggests that combined oocyte vitrification and eSCLT is a feasible minimally invasive approach associated with substantial cyst volume reduction and improvements in pain and quality of life. These findings should be interpreted as preliminary and hypothesis-generating, warranting validation in controlled comparative studies.