Comparison Between Catheter-Directed Sclerotherapy and Surgical Removal of Large Ovarian Endometriomas: A Retrospective, Single-Center Observational Study

TL;DR

This study compares catheter-directed sclerotherapy and surgery for large ovarian endometriomas, finding that sclerotherapy better preserves ovarian reserve.

Contribution

The study provides new evidence that catheter-directed sclerotherapy preserves ovarian reserve more effectively than surgery for large endometriomas.

Findings

Catheter-directed sclerotherapy resulted in smaller decreases in anti-Müllerian hormone levels compared to surgical treatment.

Surgical removal led to complete cyst size reduction, but catheter-directed sclerotherapy reduced cysts to 3.30 cm.

CA-125 levels decreased in both groups, but more significantly in the surgical group.

Abstract

Background/Objectives: The treatment options for endometriosis vary depending on individual needs and clinical circumstances. To preserve ovarian reserve, ethanol catheter-directed sclerotherapy may be considered as a treatment option. We compared the efficacy of catheter-directed sclerotherapy with that of surgical removal for the treatment of large ovarian endometriomas. Methods: This retrospective, single-center study was conducted at a tertiary care center. Patients diagnosed with ovarian endometriomas of >10 cm between 1 January 2019 and 5 December 2024 were included. Fifteen patients underwent catheter-directed sclerotherapy, and 69 underwent laparoscopic ovarian cystectomy or oophorectomy. The changes in ovarian cyst size, anti-Müllerian hormone levels, and cancer antigen 125 levels after six months of treatment were determined. Results: Before matched comparison, anti-Müllerian hormone levels decreased from 2.48 ng/mL to 1.11 ng/mL 6 months after surgical treatment. In the catheter-directed sclerotherapy group, anti-Müllerian hormone levels decreased from 1.33 ng/mL to 1.19 ng/mL. In the 1:1 matched comparison between the catheter-directed sclerotherapy and surgical groups, the anti-Müllerian hormone levels decreased by approximately −0.13 and −0.59 in the catheter-directed sclerotherapy and surgical groups, respectively. The relative reduction in the anti-Müllerian hormone levels was approximately −0.25 and −0.78 in the unilateral and bilateral ovarian surgery groups, respectively. In the surgical group, cyst size decreased to 0 cm six months after treatment, whereas CA-125 levels decreased from 62.10 U/mL to 11.20 U/mL. In the CDS group, cyst size reduced to 3.30 cm, whereas CA-125 levels decreased from 74.20 U/mL to 17.60 U/mL. Conclusions: Catheter-directed sclerotherapy preserves ovarian reserve more effectively than surgical treatment, even in cases of large endometriomas. It may be a promising treatment option for individuals with low anti-Müllerian hormone levels who are planning to conceive.

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