The result of ethanol sclerotherapy for ovarian endometrioma in patient with poor ovarian reserve: A case report

Image Description

Ovarian endometrioma is one of the most common, high-recurrence gynecological pathology that affects fertility. Almost half of the patients that were addressed to our clinic for infertility have endometriosis. Studies show that endometriomas affect 17%–44% of women with endometriosis [1]. The conventional management of ovarian endometrioma is laparoscopic cystectomy, but sclerotherapy is reported as an effective minimally invasive method for treating endometrioma, without affecting the ovarian reserve.                                 

We present the case of a 33-year-old patient, nullipara, who presented for primary infertility and pelvic pain after one year of postsurgical bilateral cystectomy for endometrioma. The diagnosis of recurrent endometrioma was confirmed through ultrasonography. We observed a 6 cm cyst on the left ovary (Figure 1), without other symptomatology, and with no ultrasound suspicion of deep endometriosis.  We offered ethanol sclerotherapy due to the low ovarian reserve (AMH 0,68 ng/ml). The technique consists of transvaginal ultrasound-guided endometrioma punction. A needle was inserted into the endometrioma and the content was aspirated (Figure 2). Next, the cyst cavity was infused with 70 % ethanol and left to act for 6 min and then removed (Figure 3, 4). We introduced the same amount of ethanol as we aspired from the cyst. The procedure is considered successful if the remaining cyst is <20 mm in diameter after sclerotherapy [2]. In conclusion, ethanol sclerotherapy for endometriomas is a rapid outpatient procedure, requiring basic equipment for a low cost and may be offered to patients with endometriomas to preserve fertility.