Endometriosis is a very common cause of infertility, we see 35% – 50% of women with infertility impacted. Endometriomas are ovarian cysts that are lined with endometrial tissue and contain menstrual debris. About a third of women with endometriosis will have endometriomas.
The treatment of these endometriomas usually involves surgery via laparoscopy and removal of the cyst and the cyst wall. The problem of the surgical resection of the cyst is that it will also cause the removal of healthy ovarian tissue containing eggs. In patients that have a poor ovarian reserve this can be problematic, because future fertility depends on having healthy viable eggs. Other complications of surgery in general such as the development of scar tissue and accidental injuries are sometimes unavoidable, this ovarian damage does not improve fertility treatment outcome.
What Is Sclerotherapy Treatment Entail?
To prevent damage to the ovarian reserve and other surgical complications a more conservative approach to the management of endometriosis and endometriomas specifically would be ideal.
Sclerotherapy provides such a conservative solution. Endometriomas can be aspirated utilizing a transvaginal ultrasound guided needle. this is an easy technique utilized for egg retrieval in in vitro fertilization. The patient is sedated while the procedure is done in minutes so that risks of surgery and laparoscopy are avoided. The problem with aspiration is that endometriomas tend to reform if the cyst wall is not removed. A clever solution is after aspiration to instill via the needle that is in place a sclerosing agent. The agent would disrupt the lining of the cyst so it does not reform once again.
Once the anesthesiologist sedates the patient, the procedure is initiated by performing a vaginal ultrasound. The needle guide is used to localize the needle as it is inserted in the cyst and the contents are aspirated. Ethanol is injected through the same needle after the contents of the cyst have been emptied. After a few minutes the ethanol is also removed. The patient recovers in the office after the procedure for a short duration prior to leaving.
What Outcome To Expect?
A systematic review and meta-analysis was performed by a group of physicians from Canada and Israel, and is published in the July 2017 issue of the journal Fertility and Sterility the official journal of the American Society of Reproductive Medicine. They included 18 studies in the publication. They concluded that management of ovarian endometrioma with the use of sclerotherapy appears to be a promising alternative to surgery, and that sclerotherapy should be considered for symptomatic women who plan to conceive. The number of oocytes retrieved was higher after endometrioma sclerotherapy compared with laparoscopic cystectomy.
At New York Fertility Institute the procedure of aspirating endometriomas has been performed successfully for more than 25 years. By aspirating the endometrioma we have been avoiding laparoscopic and abdominal procedures to preserve ovarian function and improve fertility. Every patient has a unique case and consultation with one our physicians is strongly encouraged as the first step.