Assisted Reproductive Technology Outcomes After Ethanol Sclerotherapy  in Poor Responder Patients with Endometriomas: A Before-After Clinical Trial

Farah  Ghasemi; Ladan  Kashani; Ashraf  Moini; Maryam Farid  Mojtahedi; Roza  Shahhosseini; Farzaneh   Alemohammad

doi:10.18502/jri.v25i3.17017

Farah Ghasemi Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ladan Kashani Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ashraf Moini Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Maryam Farid Mojtahedi Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Roza Shahhosseini Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Farzaneh Alemohammad Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jri.v25i3.17017

Keywords: ART outcome, Ethanol sclerotherapy, Endometriomas.

Abstract

Background: The purpose of the present study was to investigate the assisted reproductive technology (ART) outcomes after ethanol sclerotherapy (EST) in poor responder patients with endometriomas.

Methods: In this before-after clinical trial, the outcomes of ART of 31 poor responders with endometriomas were evaluated after EST between July 2023 to March 2024. These patients had undergone ART at least in one cycle before and did not respond well. Recurrence rate, antral follicle count (AFC), anti-Müllerian hormone (AMH), and relief of symptoms including dysmenorrhea and abnormal uterine bleeding (AUB) were evaluated before the procedure. Follow-up assessments were conducted two and six weeks after the procedure for evaluating the complications. Fisher’s exact test, chi-square test, and paired sample t-test were used for statistical analysis using SPSS 24.

Results: In this study, the levels of AFC and AMH increased significantly after endometrioma stripping therapy (p<0.05). Additionally, the number of embryos obtained increased significantly, indicating potential improvement in oocyte quality. There was a significant reduction in pelvic pain scores (p=0.001), as well as a notable decrease in dysmenorrhea (p=0.02) and dyspareunia (p=0.001). Moreover, 16.12% of patients reported recovery from intermenstrual bleeding. However, no significant difference was observed in the amount of gonadotropin used (p=0.56).

Conclusion: EST is an appropriate and safe procedure before ART for poor responders who have endometriomas and can be a replacement for surgery among selected patients.