What is the impact of ethanol sclerotherapy of endometriomas prior to IVF/ICSI on pregnancy rates?

We reviewed women with endometrioma(s) larger than 25 mm having IVF/ICSI cycles. All patients with a history of ovarian cystectomy were excluded. Two groups were compared: patients who had transvaginal ethanol sclerotherapy of their endometrioma(s) before ovarian stimulation and patients whose endometrioma(s) were left in situ (untreated) at the time of IVF/ICSI (control group). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The primary endpoint was progressive pregnancy rates per IVF/ICSI cycle including fresh and frozen embryo transfers. Secondary endpoints were live birth rates, the number of mature oocytes retrieved, pregnancy loss. Endometriomas recurrence rates after sclerotherapy and procedural complications were also analyzed.

A total of 96 cycles (67 patients) were included: 46 cycles (34 patients) in the ethanol sclerotherapy group and 50 cycles (33 patients) in the control group. After propensity score weighting, the pregnancy and live-birth rates were significantly higher in the ethanol sclerotherapy group compared to the control group (weighted OR, 2.9 ; 95 CI, 1.4 – 6.6 and weighted OR 2.4 ; 95 CI, 1.1 – 5.4 respectively), with a lower rate of pregnancy loss (weighted OR 0.3 ; 95 CI, 0.1 – 0.9). Ovarian response was similar in the two groups. The recurrence rate of endometrioma at 6 months after sclerotherapy was 20 %.

Sclerotherapy of endometrioma before ovarian stimulation may increase pregnancy rate, with a low rate of recurrence and a minimal risk of complication.