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Risk Factors for Recurrence and Safety Outcomes After Ethanol Sclerotherapy for Ovarian Endometriomas
Batuhan Aslan1, Necati Berk Kaplan2, Cem Atabekoğlu3
1Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Türkiye; The Graduate School of Health Sciences, Ankara University, Ankara, Türkiye.
Study Objective:
To evaluate recurrence/persistence after the initial transvaginal ultrasound-guided ethanol sclerotherapy (EST) for ovarian endometriomas, identify recurrence-associated factors, and assess feasibility, safety, and ovarian reserve outcomes after the initial procedure.
Design:
Retrospective cohort study.
Setting:
Tertiary referral center, Ankara, Türkiye.
Patients:
Women aged 18-45 years undergoing transvaginal ultrasound-guided EST for ovarian endometriomas between January 2021 and January 2026. A total of 115 EST attempts were screened; 112 were technically successful. The primary study cohort included 91 patients; time-to-event analysis was available for 88 patients.
Interventions:
A standardized 10-step transvaginal EST technique was used: aspiration, saline irrigation, instillation of 96-96.5% ethanol at 60% of aspirated volume (maximum 100 mL), 10-minute retention, and complete aspiration.
Measurements And Main Results:
Recurrence/persistence was defined as ultrasonographic detection of an endometrioma-like cyst ≥20 mm after the initial EST; repeat intervention alone was not a recurrence criterion. Recurrence/persistence occurred in 22 of 88 evaluable patients (25.0%); Kaplan-Meier cumulative estimates were 22.3% at 12 months and 29.1% at 24 months. Higher BMI was associated with recurrence/persistence in univariable analysis (HR, 1.21 per 1 kg/m; 95% CI, 1.10-1.33; P<0.001) and in the primary multivariable model (HR, 1.20; 95% CI, 1.10-1.32; P<0.001). In an expanded sensitivity model, the adjusted HR for BMI was 1.22 (95% CI, 1.11-1.35; P<0.001). Technical success was 97.4% (112/115; 95% CI, 92.6%-99.5%). Periprocedural complications occurred in 8 of 91 patients (8.8%; 95% CI, 3.9%-16.6%); no Clavien-Dindo grade IIIb-V complications occurred (0/91; 95% CI, 0.0%-4.0%). Median AMH declined modestly at 1 month (-0.16 ng/mL; P<0.001) and 6 months (-0.12 ng/mL; P=0.019).
Conclusion:
EST achieved high technical success in this carefully selected cohort. Recurrence/persistence remained clinically relevant, and higher BMI was associated with recurrence/persistence across primary and sensitivity analyses. This observational association should not be interpreted as causal, and the absence of histological confirmation limits conclusions regarding oncologic safety.
