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Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis

  • Interventional
  • Published:
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Abstract

Objective

Catheter-directed ethanol sclerotherapy (CDS) is known to less affect the ovarian function, with comparable efficacy. This study aims to investigate the change in ovarian reserve after catheter-directed ethanol sclerotherapy in patients with recurrent endometrioma, as compared to primary endometrioma.

Materials and methods

Retrospective, observational study. Electronic medical records and images of patients with endometrioma who underwent CDS from August 2014 to April 2022 at a single institution were obtained. Patients aged > 18 years old and with anti-Müllerian hormone (AMH) level between 0.8 and 10.0 with regular menstruation were enrolled. Cyst diameter, laterality, AMH level, and CA-125 level before and after 1 month, 6 months, 1 year, 2 years, and 3 years of sclerotherapy were obtained.

Results

A total of 180 patients were fit for analysis. There was no statistical difference in age and cyst size between the two groups. Mean values of AMH in each group were 3.35 in the primary group and 3.00 in the recurrent group prior to the procedure (p = 0.347). There was no significant difference in delta value of AMH after sclerotherapy in both groups at each follow-up period. Also, this result was consistent when stratified by laterality, preprocedural AMH level, and initial size of endometrioma. No case of recurrence was reported in both groups.

Conclusions

The effect of CDS on ovarian reserve is not inferior in recurrent endometrioma compared to primary endometrioma. Since sclerotherapy is known to less deteriorate the ovarian function than surgical removal of endometrioma, clinician could consider this as the first-line therapy in patients with recurrent endometrioma.

Clinical relevance statement

Catheter-directed ethanol sclerotherapy for patients with recurrent endometrioma has similar effect on ovarian reserve compared to patients with primary endometrioma.

Key Points

• Secondary surgery for endometrioma has significant deleterious effect on ovarian function.

• Catheter-directed sclerotherapy (CDS) for endometrioma had equally minimal adverse effect on ovarian reserve, represented as anti-Müllerian hormone (AMH), in both primary and recurrent groups.

• Physicians should consider CDS for patients with recurrent endometrioma who desire to preserve ovarian function.

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Abbreviations

AFC:

Antral follicle count

AMH:

Anti-Müllerian hormone

BMI:

Body mass index

CA-125:

Cancer antigen 125

CDS:

Catheter-directed sclerotherapy

FSH:

Follicle-stimulating hormone

IQR:

Interquartile range

PCOS:

Polycystic ovarian syndrome

PSM:

Propensity score matching

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (NRF-2020R1C1C1013849). This study was also supported by a CMB-Yuhan research grant of Yonsei University College of Medicine (6–2018-0173).

Author information

Author notes

  1. Heeyon Kim and Seok Kyo Seo equally contributed to this work as co-corresponding authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea

    Jae Kyung Lee, Euna Choi, Jinkyung Baek, Heeyon Kim & Seok Kyo Seo

  2. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea

    Kichang Han & Man-Deuk Kim

  3. College of Natural Science, School of Statistics, University of Seoul, 163, Seoulsiripdae-Ro, Dongdaemun-Gu, Seoul, 02504, South Korea

    Hae-Rim Kim

Authors
  1. Jae Kyung Lee
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  2. Kichang Han
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  3. Euna Choi
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Corresponding authors

Correspondence to Heeyon Kim or Seok Kyo Seo.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Seok Kyo Seo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Hae-Rim Kim).

Informed consent

Written informed consent was waived by the Institutional Review Board, owing to the retrospective nature of the study.

Ethical approval

Approval was obtained from the Institutional Review Board of the Severance Hospital, Yonsei University College of Medicine (approval no. 4–2021-1793).

Study subjects or cohorts overlap

Fifty-six of 180 patients who had undergone CDS have been previously reported [10]. The prior study was a study focused on patients at risk for decreased ovarian reserve, whereas in this manuscript, we compared effect of CDS on AMH between the primary group and recurrent group.

Methodology

• retrospective

• observational

• performed at one institution

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Lee, J.K., Han, K., Choi, E. et al. Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis. Eur Radiol 34, 3298–3308 (2024). https://doi.org/10.1007/s00330-023-10320-z

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  • DOI: https://doi.org/10.1007/s00330-023-10320-z

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