Ovarian reserve and IVF outcomes after ethanol ovarian sclerotherapy in women with endometrioma: a systematic review and meta-analysis.

Sclerotherapy has emerged as a promising treatment for endometrioma, a gynaecological condition characterized by high recurrence and significant impacts on fertility. Unlike traditional surgery, sclerotherapy offers the advantage of preserving ovarian reserve; however, limited data exist regarding its effects on women of reproductive age undergoing IVF. This study compared ovarian reserve and IVF outcomes between ethanol-only sclerotherapy and cystectomy for endometrioma. A systematic search PubMed, Embase, Scopus, Google Scholar, Medline, ClinicalTrials.gov and the Cochrane Central register of controlled trials was conducted using the keywords 'sclerotherapy and endometrioma', 'cystectomy and endometrioma' and 'sclerotherapy'. A total of 28 studies involving 1877 patients were included in the analysis, demonstrating that sclerotherapy significantly preserved ovarian reserve, as evidenced by a smaller change in anti-Müllerian hormone concentrations compared with cystectomy. Additionally, IVF outcomes favoured sclerotherapy, with higher clinical pregnancy rates and an increased number of total oocytes, metaphase II oocytes and embryos. However, the differences in fertilization rates and gonadotrophin dosage were not significant. Based on these findings, sclerotherapy should be considered as a viable treatment option for women with endometrioma, particularly for those with low ovarian reserve who are concerned about their future fertility. This treatment appears to offer the dual benefits of preserving ovarian function and enhancing fertility outcomes after treatment.