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Endometriomas: Sclerotherapy Provides a Non-Surgical Solution

Dr. Geoffrey Sher Recommends

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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 eff ective 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.

Tags: chocolate cyst, endometriomas, Endometriosis, IVF Authority, ovarian cysts, sclerotherapy

12 Responses to “Endometriomas: Sclerotherapy Provides a Non-Surgical Solution”

linda says:

October 27, 2009 at 12:39 pm

Dr. Sher,

Is this procedure (sclerotherapy) offered at the NY office? I am scheduled for an ovarian cyst aspiration there on Thursday – I also have an endometrioma on my other ovary (which is being non productive due to the endometrioma) and wonder if they can tackle this at the same time.

How soon after sclerotherapy can IVF be done? I am 44 so I'm interested in the quickest/best solution.

Thank you.

Reply
Geoffrey Sher, MD says:

October 27, 2009 at 1:26 pm

Yes! It is available at all SIRM centers and you need a 6 week break before IVF.

Good luck!

Geoff Sher

Reply
linda says:

October 27, 2009 at 1:46 pm

Thanks Dr. Sher. I think Dr. T's office is trying to schedule the procedure for me as we write. I hope this works as I've been experienced quite a bit of ovarian pain from the endometrioma. I am relieved that there is an answer to this outside of having a lap to remove it.

Reply
Stefanie says:

May 10, 2011 at 6:33 am

Dr. Sher, My name is Stefanie. I am suffering from endometrisis and ovarian cysts as a result. My doctor has performed fluid aspiration twice and the cyst is back. Can you please help me? It is hard for me to conduct my daily life in constant pain.

Reply
carol says:

December 6, 2012 at 4:58 am

Dr Sher, I have endo and currently have 5 frozen embryos. I plan on doing the et in January 2013. I have two endo cysts on each side 6 cm and 9 cm. My Dr said the cysts should not decease my chance with the et. Do I need to address the cysts before the et? I need your advice pls help.

Carol

Reply
- Geoffrey Sher says:
  
  December 6, 2012 at 9:43 am
  
  Respectfully, I disagree. Sizable endometriomas will likely interfere with egg quality in the affected ovary(ies). They would need removal or sclerotherapy. See my blog on this site on endo. Also, be aware that about 1/3 of women with endiometriosis have immunologic implantation issues relating to NK cell activation. This would need attention in my opinion, if IVF is to have a reasonable chance
  
  Geoff Sher
  
  Reply
Mary says:

February 8, 2013 at 3:44 pm

How much pain is normal to experience after sclerotherapy of an endometrioma? My doctor did this procedure yesterday using 95% ethanol because he couldn’t find the tetracycline anymore to treat a small endometrioma on my left ovary. He said the ethanol leaked out of the cyst. I experienced a LOT of pain after the procedure and am still in pain (Vicodin helps, but I still have aching and stabbing/pulling pains even after taking Vicodin). Is it normal to need narcotic pain medication after sclerotherapy?

Reply
- Geoffrey Sher says:
  
  February 8, 2013 at 7:18 pm
  
  I do not use ethanol for this. We use 5% tetracycline hydrochloride and yes…if it leaks out it can cause severe pain. To avoid this from happening, we infuse sterile normal saline (about 1.5 liters into the pelvic cavity in advance so that if leakage occurs it dilutes out in the saline solution.. Then after the procedure we drain out the pelvic saline. In this way pain is minimized.
  
  Geoff Sher
  
  Reply
Mary says:

February 9, 2013 at 6:51 am

I just read that this says there is the possibility of adhesion formation with this procedure. I just got pregnant 100% naturally (from my left ovary no less) and miscarried two weeks ago. I was doing IVF only to freeze eggs for the future but intended to try to conceive naturally again after that. Now I’m worried that this procedure just took a perfectly functioning system and broke it! There is no way this didn’t cause damage somehow with the amount of pain I’m having. He didn’t tell me this was not a good option for someone with open tubes who could get pregnant naturally.

Reply
- Geoffrey Sher says:
  
  February 9, 2013 at 11:25 pm
  
  Egg Retrieval should in no way expose you to pelvic adhesions. I have been doing IVF for >30 years and have not seen this happen.
  
  Geoff Sher
  
  Reply
Mary says:

February 10, 2013 at 8:41 am

Not egg retrieval – sclerotherapy of an endometrioma is what is written at the top of this page as saying can cause adhesions. My doctor did the sclerotherapy on me with 95% ethanol 3 days ago and it leaked. I have had pain so bad it requires narcotic pain medication and went to the ER yesterday where I only got relief with dilaudid. They did an ultrasound and discharged me and said it looks normal – but this amount of pain is NEVER normal to me. The ER doctor spoke with the doctor who did my sclerotherapy and he told her it was just alcohol and so it is only irritating and can’t have caused any damage inside if it leaked. I had a perfectly functional set of tubes and ovaries prior to this sclerotherapy because I had a clear HSG and just got pregnant naturally (but miscarried). Your page says sclerotherapy should only be done in patients who cannot get pregnant any other way than with IVF. I’m worried that now I will have scarring because he did sclerotherapy and the sclerosant leaked – I’m in horrible pain for days and nobody seems the least bit concerned – especially the doctor who did the sclerotherapy.

Reply
- Geoffrey Sher says:
  
  February 10, 2013 at 7:53 pm
  
  Indeed, sclerotherapy can cause adhesions. That is why I do not recommend it in cases where a commitment to IVF has not been made. As I said, we do not use alcohol for sclerotherapy of endometriomas. We use 5% tetracycline hydrochloride. And yes, leakage causes pain and that is why we infuse 1500cc of saline solution before the procedure and extract it afterwards (as I described in my previous response to you).
  
  Good luck!
  
  Geoff Sher
  
  Reply

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