Ethanol Sclerotherapy for Primary and Recurrent Endometrioma Improves In Vitro Fertilization Pregnancy Outcomes: A Randomized Clinical Trial.

OBJECTIVE: Alcohol sclerotherapy has been shown to reduce endometrioma recurrence and improve ovarian response, including the number of retrieved oocytes and antral follicle count (AFC), compared with surgical cystectomy. This randomized clinical trial aimed to assess the effect of ethanol sclerotherapy on assisted reproductive outcomes in women with a history of primary and recurrent endometriomas. MATERIALS AND METHODS: This single-blind randomized clinical trial included 80 infertile women aged 20-40 years with either primary or recurrent endometriomas. All participants underwent transvaginal ultrasound to evaluate endometrioma size, AFC, and serum hormone levels (anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH)) in the follicular phase. Patients were randomly assigned to the intervention group (n=40), receiving ethanol sclerotherapy, or the control group (n=40), receiving Dipherelin treatment. The sclerotherapy procedure involved cyst aspiration followed by ethanol instillation, with standard post-procedure care. Ovulation induction was performed, and subsequent reproductive outcomes, including pregnancy rates, were assessed in the same cycle. RESULTS: The mean age of participants was 32.4 ± 4.75 years, and the mean endometrioma size was 41.45 ± 15.9 mm. Baseline characteristics and complications rates did not differ significantly between groups. Endometrioma recurrence was observed in 20% of patients in the intervention group within six months. Embryo quality was not significantly higher in the intervention group (P>0.05). Chemical pregnancy rates were 40% in the intervention group versus 20% in the control group (P=0.025), and clinical pregnancy rates were 32.5 versus 15% (P=0.040). Conception and implantation rates, however, did not differ significantly between groups. CONCLUSION: Ethanol sclerotherapy significantly improved clinical and chemical pregnancy rates compared to the control, suggesting that it may be a viable alternative to surgical cystectomy in selected patients, particularly those undergoing in vitro fertilization (registration number: IRCT20191206045629N1).