Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization.
OBJECTIVE
Conventional treatment of endometriosis involves drainage and removal of the cyst wall, which often results in inadvertent resection of normal ovarian tissue. We previously reported that 12 patients were successfully treated with sclerotherapy using 5% tetracycline. We now report our experience with sclerotherapy before in vitro fertilization (IVF) in an additional 20 patients with ovarian endometriomas.


METHODS
Prospective, cohort.


METHODS
Private practice.


METHODS
Women (n = 32) with sonographic evidence of an ovarian endometrioma were offered sclerotherapy in lieu of laparoscopy.


METHODS
Sclerotherapy was performed under conscious sedation and transvaginal ultrasound guidance. An 18-gauge, single-lumen needle was inserted into the endometrioma, and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Tetracycline (5%) (5-10 mL) was then instilled into the cyst. Saline was injected into the cul-de-sac to dilute any tetracycline that may have leaked. The fluid was then removed. Ultrasound was performed 6 weeks later to assess the efficacy of treatment.


METHODS
Resolution of endometrioma and subsequent IVF pregnancy rate.


RESULTS
Complete resolution was observed in 24 (75%) of 32 patients, at follow-up exam. Repeat aspiration of watery fluid was required in eight patients before resolution. Repeat treatment with tetracycline was needed in two patients. Only one patient did not ultimately respond. In vitro fertilization was performed in 28 patients; an ongoing gestation resulted in 16 (57%) from the next cycle.


CONCLUSIONS
Sclerotherapy with 5% tetracycline is a simple, effective (and, in our limited series, safe) alternative to surgical intervention for treatment of endometriomas before IVF.
Sher Institute for Reproductive Medicine, 3121 S. Maryland Parkway, Las Vegas, Nevada 89109, USA. jfisch@sherinstitute.com
Jeffrey D
JD
Fisch
Geoffrey
G
Sher
D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000628:therapy; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy / Q000706:statistics & numerical data*; D015911:Sclerotherapy / Q000379:methods*; D013752:Tetracycline; D016896:Treatment Outcome; D014463:Ultrasonography
D013752:Tetracycline