Ovarian Sclerotherapy
What Is An Ovarian Endometrioma?
An Endometrioma is a type of benign (non-cancerous) ovarian cyst situated within the ovary. This type of ovarian cyst is lined with the same cells that line the endometrial cavity of the uterus and are filled with a thick chocolate colored material, which is the reason they are also known as "chocolate cysts". Endometriomas occur most often during a woman's childbearing years and as many as 5½ million women of reproductive age in the US are estimated to be effected by some form of endometriosis.
Endometriomas and Infertility
Although the cause of endometriosis is not known, endometriotic cysts are well known to contribute to infertility. The presence of an endometriotic cyst actually eliminates a relatively significant portion of a woman's egg reserve, thereby diminishing her fertility. There is also evidence from several IVF studies that suggests the presence of endometriomas in the ovaries may have a negative effect upon egg quality.
What Are The Symptoms?
Symptomatically, it is associated with generalized pelvic pain, painful menstruation, discomfort with during sexual relations and infertility.
How Is An Endometrioma Diagnosed?
Ovarian endometriomas are best diagnosed with transvaginal ultrasonography.
What Treatment Options Are Available?
Surgical removal of the cyst is the only therapeutic option, since hormonal therapy has been shown to be entirely ineffective. There is a cyst recurrence rate of 15% to 25% after surgical treatment
The Ovarian Sclerotherapy Procedure
This procedure entails the ultrasound-guided aspiration of an ovarian cyst, followed by the insertion of a sclerosing agent (95% Ethyl Alcohol or 5% Tetracycline solution), which chemically destroys the cyst lining so as to prevent the re-growth of the cyst. It is performed in a manner similar to an egg retrieval procedure in IVF (In Vitro Fertilization). The procedure takes approximately 20-30 minutes to perform, during which time the patient is under Propolfol anesthesia.
There are several advantages to this procedure. It avoids major abdominal or laparoscopic surgery to remove the cyst, so there is usually considerably less recovery time and postoperative discomfort for the patient. Most importantly, for women currently desiring conception or who are concerned for their future fertility, this procedure is more likely to spare ovarian tissue containing their egg reserve. With the surgical treatments, larger amounts of ovarian tissue must be removed in order to completely remove the cyst. When the ovary is sutured, even more ovarian tissue may be compromised. When the ovarian cyst is removed surgically with a laser or electrocautery, additional healthy tissue surrounding the cyst may be lost. The advantage of sclerotherapy is that it only destroys the cyst lining by direct contact and does not penetrate into healthy ovarian tissue.
As in any medical or surgical treatment, there are certain associated risks, such as infection or internal bleeding, which may require intravenous antibiotic therapy, hospitalization, or corrective surgical intervention. Sclerotherapy has similar risks. Patients are given antibiotics prior to the procedure and again thereafter to limit the possibility of an infection or an abscess forming in the ovary. There may also be irritation or discomfort from the sclerosing agent in the abdominal and pelvic area post-operatively. To limit this possibility, after treating the cyst with the sclerosing agent for 10 minutes, the agent is removed from the cyst and the area is thoroughly rinsed with sterile saline (salt water). The pelvic and abdominal areas are also irrigated with saline to prevent chemical irritation to those regions. Postoperative discomfort is managed with pain medication and will usually resolve, if present, within 24 hours.
The recurrence rate of endometriomas treated with sclerotherapy is about 15%. The recurrence rate with surgical approaches ranges between 15-25%. The only way that a 0% recurrence can be ensured is if the entire ovary is removed, which is obviously undesirable in cases in which fertility is of importance.