90 - Comparison of Image-Guided Endometrioma Sclerotherapy vs Laparoscopic Cystectomy: A Systematic Review

Purpose: Endometriomas are a common cause of infertility and pelvic pain in reproductive-age women {1,2}. Laparoscopic cystectomy may reduce ovarian reserve {3}, while image-guided sclerotherapy offers a minimally invasive, fertility-preserving alternative {4}. This review compares outcomes of sclerotherapy versus cystectomy, focusing on ovarian reserve, recurrence, fertility, and complications.

Materials and Methods: We systematically searched PubMed, Scopus, and Embase from inception. References were imported into Rayyan, duplicates removed, and abstracts/full texts screened independently by blinded reviewers with conflicts resolved by consensus, with rigorous adherence to PRISMA. Eligible studies compared percutaneous/image-guided sclerotherapy with laparoscopic cystectomy for ovarian endometriomas; animal, in vitro, and review articles were excluded. Extracted outcomes included recurrence, ovarian reserve (AMH, FSH, AFC), fertility, and postoperative complications.

Results: Across 42 studies, with 4,783 total patients: 2,145 sclerotherapy, 2,312 cystectomy, most used 95–100% ethanol (34 studies) or tetracycline (2), with ultrasound guidance in 24. Mean cyst size was ~30–40 mm, follow-up 1–12 months. Sclerotherapy showed fewer complications (< 5%, mostly mild; rare hemorrhage, minimal infection/adhesions) but higher recurrence (15–25% vs 8–12%). Cystectomy caused more complications (8–12%, including adhesions/bleeding) and greater declines in ovarian reserve (AMH −0.7 to −3.2 ng/mL, AFC −2.5) compared with sclerotherapy (AMH −0.1 to −1.4 ng/mL, AFC −1.96). FSH changes were minimal in both. Fertility outcomes favored sclerotherapy for spontaneous pregnancy, while MAR/IVF outcomes and overall live birth rates were comparable.

Category	Patients (n)	Recurrences (n)	Recurrence rate (%)	P-value
Sclerotherapy	298	65	21.80%	0.0033*
Cystectomy	153	53	34.60%

Table 1. Recurrence outcomes after sclerotherapy vs cystectomy. Note: *p< 0.05

Category	Patients (n)	Pregnancies (n)	Pregnancy rate (%)	P-value
Sclerotherapy	206	47	22.80%	0.0135*
Cystectomy	153	53	34.60%

Table 2. Fertility and pregnancy outcomes. Note: *p< 0.05

Conclusion: Image-guided sclerotherapy is a promising alternative to cystectomy, better preserving ovarian reserve and spontaneous pregnancy while showing comparable IVF and live birth rates. Recurrence was higher after sclerotherapy, underscoring the need for larger RCTs with standardized protocols, long-term follow-up, and cost-effectiveness analyses to better guide future clinical practice and patient decision-making.