Endometriomas: Sclerotherapy Provides a Non-Surgical Solution

30 Jun
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Sclerotherapy and Endometriosis

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 effective 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.

44 Comments

  • Janelle says:

    Dr Sher.
    I have one ovary because my other ovary was surgically removed in 2009 due to a cyst, not sure if it is endometrioma, my question is since i only have one ovary and my AMH is 0.567 the last time i check, I am very worried about surgically removing the cyst so it doesnt affect my only working ovary. In addition, to this, I have tried multiple failed IVFs, 1 fresh and 2FET. I have done 2 hscope in addition to my FET prep and also done ERA testing and my previous doc seems to believe everything looks good with the uterus. Will you advise i remove the cyst? I am 40 years old.

    • Geoffrey Sher says:

      My website has changed. The new site is at http://www.sherIVF.com where I host and populate new and updated blog articles . The blog can also be accessed directly by going to http://goo.gl/4hvjoP. I now only respond to posts on this new site

      To find and follow updated and new blog articles and to post questions or comments, please use this new venue. I promise to respond promptly.

  • Jacob says:

    Hi Dr. Sher, you mentioned in your other post that all ovarian cysts that persist for longer than 6 weeks (whether in non-pregnant or pregnant women), should be treated by surgical removal, followed by pathological analysis. And now you are saying Endometriomas can be treated without the surgery. The problem is how to make sure the ovarian cyst is Endometriomas cyst in the first place. Do this mean I need to do laparoscopy first to determine it’s Endometriomas cyst, and then do Sclerotherapy. Is there anyway to avoid the initial laparoscopy? Thanks!

    • Geoffrey Sher says:

      No Sclerotherapy can supplant surgery.Please go to the home page of this blog, http://www.IVFauthority.com . When you get t there, find the search bar and type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “Endometriosis”

      2. Sclerotherapy of Ovarian Endometriomas”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      • Jacob says:

        Dr. Sher, thanks for your response. I did schedule the appointment, and it’s three months away, which is a very long wait.
        My question is how to diagnose Ovarian Endometriomas and differentiate from other ovarian cyst in the first place.
        Is that something done by ultrasound or by laparoscopy?I just don’t want to do laparoscopy.
        I know Sclerotherapy of Ovarian Endometriomas will happen next. Thanks!

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