Endometriomas: Sclerotherapy Provides a Non-Surgical Solution

In the field of assisted reproductive technology (ART), there are generally two reasons for the treatment of endometriosis. The first is to alleviate symptoms of pain. The second is in preparation for in vitro fertilization (IVF).

Traditional surgical treatment of ovarian cysts or endometriomas involves gaining access to the ovary(ies) through an abdominal incision, or via laparoscopy, for drainage of the cyst contents and subsequent removal of the cyst wall. Unfortunately, in many cases, normal ovarian tissue is inadvertently removed along with the cyst wall, which may decrease the number of available oocytes for subsequent fertility treatment. A large percentage of such women have advanced stage disease and have had multiple previous surgeries. In the presence of pelvic adhesions, visualization of anatomic structures may be inadequate, leading to a higher incidence of cyst recurrence. This may further diminish the potential response to ovarian stimulation with gonadotropins. Additionally, women with advanced endometriosis are more likely to develop pelvic adhesions as well as an increased risk of surgical complications.

Instead of surgical management, we at SIRM advocate the use of a treatment known as sclerotherapy in women with endometriomas who are preparing for IVF treatment. Sclerotherapy is an effective non-surgical treatment for endometriosis of the ovary. It involves needle aspiration of the gelatinous content of the endometriotic cyst, followed by flushing the cyst with a 5% tetracycline solution. In more than 75% of cases, treatment results in disappearance of the lesion within 6 to 8 weeks.

Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia. It has the advantage of being an ambulatory office-based procedure at a low cost, with a low incidence of significant post-procedural pain or complications, and the avoidance of the need for surgery.

Sclerotherapy is a safe and eff ective alternative to surgery. It is a definitive treatment, even for recurrent ovarian endometriomas, in properly selected patients planning to undergo IVF. Since the procedure is associated with a small, but realistic possibility of adhesion formation, it should only be used in cases where IVF is the only fertility treatment appropriate for a patient. Women who intend to try and conceive through natural conception or intrauterine insemination will be better off undergoing standard laparotomy or laparoscopy to treat their endometriomas.