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Aflatoonian, A., & Tabibnejad, N. (2020). Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: A retrospective cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 13(11), 935–942. https://doi.org/10.18502/ijrm.v13i11.7960
https://doi.org/10.18502/ijrm.v13i11.7960
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Abbas Aflatoonian
Abbas Aflatoonian
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Nasim Tabibnejad
Nasim Tabibnejad
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Published Date
- Nov 22, 2020
Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: A retrospective cross-sectional study
Abstract
Background: Endometrioma is a common high-recurrence gynecological disease that affects infertility. Surgical resection using laparotomy or laparoscopy is applied as a standard treatment. Moreover, sclerotherapy is reported to be effective as a noninvasive method for treating endometrioma.
Objective: To evaluate whether the ethanol retention or aspiration after sclerotherapy improve pregnancy outcome in infertile women with endometrioma.
Materials and Methods: In a retrospective study, hospital records of 43 women with recurrent or bilateral endometrioma who had been undergone transvaginal ultrasound sclerotherapy were reviewed. They were selected to receive either ethanol for 10 min, ethanol injection, irrigation, and then aspiration or total retention without aspiration based on the surgeon’s decision. The participants were followed-up for 3, 6 and 12 months for natural or artificial conception as well as for cyst recurrence.
Results: Chemical pregnancy was positive in 52% of the women in the aspiration group and 53.8% in the retention group. Ongoing pregnancy (44% vs 46.2%, p = 0.584) and live birth (40% vs 46.2%, p = 0.490) were reported marginally higher in the retention group compared with the aspiration group, and the differences were not statistically significant. Moreover, the recurrence rate were found to be 48.1% and 37.5% in the aspiration and retention groups, respectively (p = 0.542). The cysts size in the retention group was significantly correlated to the recurrence rate.
Conclusion: Both the aspiration and left in situ of ethanol 95% sclerotherapy have the similar impact on the treatment of ovarian endometrioma regarding pregnancy and recurrence rate. However, larger randomized studies with strict inclusion criteria are needed.
Key words: Endometrioma, Ethanol, Sclerotherapy, In vitro fertilization, Pregnancy rate.
References
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[15] Ferrero S, Remorgida V, Venturini PL, Leone Roberti Maggiore U. Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study. Eur J Obstet Gynecol Reprod Biol 2014; 174: 117–122.
[16] Vercellini P, DE Matteis S, Somigliana E, Buggio L, Frattaruolo MP, Fedele L. Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2013; 92: 8–16.
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[18] Hsieh CL, Shiau CS, Lo LM, Hsieh TT, Chang MY. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril 2009; 91: 2709–2713.
[19] Kars B, Buyukbayrak EE, Karsidag AY, Pirimoglu M, Unal O, Turan C. Comparison of success rates of ’transvaginal aspiration and tetracycline sclerotherapy’ versus ’only aspiration’ in the management of non-neoplastic ovarian cysts. J Obstet Gynaecol Res 2012; 38: 65–69.
[20] Yazbeck C, Madelenat P, Ayel JP, Jacquesson L, Bontoux LM, Solal P, et al. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online 2009; 19: 121–125.
[21] Gatta G, Parlato V, Di Grezia G, Porto A, Cappabianca S, Grassi R, et al. Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts. Radiol Med 2010; 115: 1330–1339.
[22] Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril 2017; 108: 117– 124.
[23] Chang MY, Hsieh CL, Shiau CS, Hsieh TT, Chiang RD, Chan CH. Ultrasound-guided aspiration and ethanol sclerotherapy (EST) for treatment of cyst recurrence in patients after previous endometriosis surgery: analysis of influencing factors using a decision tree. J Minim Invasive Gynecol 2013; 20: 595–603.
[24] Aflatoonian A, Rahmani E, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial. Iran J Reprod Med 2013; 11: 179–184.
[25] Nisolle M. Ovarian endometriosis and peritoneal endometriosis: are they different entities from a fertility perspective? Curr Opin Obstet Gynecol 2002; 14: 283–288.
[26] Andre GM, Vilarino FL, Christofolini DM, Bianco B, Barbosa CP. Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization - a pilot study. Einstein (Sao Paulo) 2011; 9: 494–498.
[27] Lee KH, Kim CH, Lee YJ, Kim SH, Chae HD, Kang BM. Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma. Obstet Gynecol Sci 2014; 57: 297–303.
[28] Noma J, Yoshida N. Efficacy of ethanol sclerotherapy for ovarian endometriomas. Int J Gynaecol Obstet 2001; 72: 35–39.
[29] Kafali H, Yurtseven S, Atmaca F, Ozardali I. Management of non-neoplastic ovarian cysts with sclerotherapy. Int J Gynaecol Obstet 2003; 81: 41–45.
[30] Garcia-Tejedor A, Castellarnau M, Ponce J, Fernandez ME, Burdio F. Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 187: 25–29.
[31] Castellarnau M, Garcia-Tejedor A, Carreras R, Cayuela E, Ponce J. Ultrasound-guided aspiration with and without ethanol sclerotherapy in the management of simple adnexal cysts: A singlecenter experience. J Minim Invasive Gynecol 2016; 23: 242–251.
[32] Zanetta G, Lissoni A, Torri V, Dalla Valle C, Trio D, Rangoni G, et al. Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study. BMJ 1996; 313: 1110–1113.
[33] Koike T, Minakami H, Motoyama M, Ogawa S, Fujiwara H, Sato I. Reproductive performance after ultrasound-guided transvaginal ethanolsclerotherapy for ovarian endometriotic cysts. Eur J Obstet Gynecol Reprod Biol 2002; 105: 39–43.
[34] Messalli EM, Cobellis G, Pecori E, Pierno G, Scaffa C, Stradella L, et al. Alcohol sclerosis of endometriomas after ultrasound-guided aspiration. Minerva Ginecol 2003; 55: 359–362.
[35] Goncalves FC, Andres MP, Passman LJ, Goncalves MO, Podgaec S. A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma. Int J Gynaecol Obstet 2016; 134: 3–7.
[2] Harada T. Dysmenorrhea and endometriosis in young women. Yonago Acta Med 2013; 56: 81–84.
[3] Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27: 441–447.
[4] Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Delpiano EM, Marchino GL, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online 2011; 23: 740–746.
[5] Muzii L, Achilli C, Lecce F, Bianchi A, Franceschetti S, Marchetti C, et al. Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery. Fertil Steril 2015; 103: 738–743.
[6] Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97: 3146–3154.
[7] Dilek U, Pata O, Tataroglu C, Aban M, Dilek S. Excision of endometriotic cyst wall may cause loss of functional ovarian tissue. Fertil Steril 2006; 85: 758– 760.
[8] Unlu C, Yildirim G. Ovarian cystectomy in endometriomas: Combined approach. J Turk Ger Gynecol Assoc 2014; 15: 177–189.
[9] Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L. Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 2010; 25: 678–682.
[10] Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 2010; 11: CD008571.
[11] Esinler I, Bozdag G, Aybar F, Bayar U, Yarali H. Outcome of in vitro fertilization/ intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomas. Fertil Steril 2006; 85: 1730–1735.
[12] Somigliana E, Arnoldi M, Benaglia L, Iemmello R, Nicolosi AE, Ragni G. IVF-ICSI outcome in women operated on for bilateral endometriomas. Hum Reprod 2008; 23: 1526–1530.
[13] Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2009; 92: 75–87.
[14] Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al.ESHRE guideline: Management of women with endometriosis. Hum Reprod 2014; 29: 400–412.
[15] Ferrero S, Remorgida V, Venturini PL, Leone Roberti Maggiore U. Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study. Eur J Obstet Gynecol Reprod Biol 2014; 174: 117–122.
[16] Vercellini P, DE Matteis S, Somigliana E, Buggio L, Frattaruolo MP, Fedele L. Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2013; 92: 8–16.
[17] Psaroudakis D, Hirsch M, Davis C. Review of the management of ovarian endometriosis: paradigm shift towards conservative approaches. Curr Opin Obstet Gynecol 2014; 26: 266–274.
[18] Hsieh CL, Shiau CS, Lo LM, Hsieh TT, Chang MY. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril 2009; 91: 2709–2713.
[19] Kars B, Buyukbayrak EE, Karsidag AY, Pirimoglu M, Unal O, Turan C. Comparison of success rates of ’transvaginal aspiration and tetracycline sclerotherapy’ versus ’only aspiration’ in the management of non-neoplastic ovarian cysts. J Obstet Gynaecol Res 2012; 38: 65–69.
[20] Yazbeck C, Madelenat P, Ayel JP, Jacquesson L, Bontoux LM, Solal P, et al. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online 2009; 19: 121–125.
[21] Gatta G, Parlato V, Di Grezia G, Porto A, Cappabianca S, Grassi R, et al. Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts. Radiol Med 2010; 115: 1330–1339.
[22] Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril 2017; 108: 117– 124.
[23] Chang MY, Hsieh CL, Shiau CS, Hsieh TT, Chiang RD, Chan CH. Ultrasound-guided aspiration and ethanol sclerotherapy (EST) for treatment of cyst recurrence in patients after previous endometriosis surgery: analysis of influencing factors using a decision tree. J Minim Invasive Gynecol 2013; 20: 595–603.
[24] Aflatoonian A, Rahmani E, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial. Iran J Reprod Med 2013; 11: 179–184.
[25] Nisolle M. Ovarian endometriosis and peritoneal endometriosis: are they different entities from a fertility perspective? Curr Opin Obstet Gynecol 2002; 14: 283–288.
[26] Andre GM, Vilarino FL, Christofolini DM, Bianco B, Barbosa CP. Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization - a pilot study. Einstein (Sao Paulo) 2011; 9: 494–498.
[27] Lee KH, Kim CH, Lee YJ, Kim SH, Chae HD, Kang BM. Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma. Obstet Gynecol Sci 2014; 57: 297–303.
[28] Noma J, Yoshida N. Efficacy of ethanol sclerotherapy for ovarian endometriomas. Int J Gynaecol Obstet 2001; 72: 35–39.
[29] Kafali H, Yurtseven S, Atmaca F, Ozardali I. Management of non-neoplastic ovarian cysts with sclerotherapy. Int J Gynaecol Obstet 2003; 81: 41–45.
[30] Garcia-Tejedor A, Castellarnau M, Ponce J, Fernandez ME, Burdio F. Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 187: 25–29.
[31] Castellarnau M, Garcia-Tejedor A, Carreras R, Cayuela E, Ponce J. Ultrasound-guided aspiration with and without ethanol sclerotherapy in the management of simple adnexal cysts: A singlecenter experience. J Minim Invasive Gynecol 2016; 23: 242–251.
[32] Zanetta G, Lissoni A, Torri V, Dalla Valle C, Trio D, Rangoni G, et al. Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study. BMJ 1996; 313: 1110–1113.
[33] Koike T, Minakami H, Motoyama M, Ogawa S, Fujiwara H, Sato I. Reproductive performance after ultrasound-guided transvaginal ethanolsclerotherapy for ovarian endometriotic cysts. Eur J Obstet Gynecol Reprod Biol 2002; 105: 39–43.
[34] Messalli EM, Cobellis G, Pecori E, Pierno G, Scaffa C, Stradella L, et al. Alcohol sclerosis of endometriomas after ultrasound-guided aspiration. Minerva Ginecol 2003; 55: 359–362.
[35] Goncalves FC, Andres MP, Passman LJ, Goncalves MO, Podgaec S. A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma. Int J Gynaecol Obstet 2016; 134: 3–7.