Transvaginal Ethanol Sclerosis Versus Saline Aspiration of Endometriomas Prior to IVF: A Randomized Controlled Trial

Endometriosis affects 6-10% of reproductive age women and is detected in 21-47% of women with infertility [1,2]. Notably, it is also present in 20-40% of women undergoing IVF and is often associated with lower rates of live births, clinical pregnancy and implantation rates [3-5]. Women with Stage III and IV endometriosis can develop endometriomas, or cysts arising from ectopic endometrial tissue implanted in the ovary with invagination of the ovarian cortex. In the setting of IVF, endometriomas can make oocyte aspiration difficult due to limited visualization of the follicular cohort [6,7]. As a result, clinicians often obtain a lower yield of oocytes [4]. In addition, there is an increased risk of inadvertent fenestration of the endometrioma, which has been shown to cause inflammatory peritonitis, and if aspirated into the egg retrieval needle, can be detrimental to the oocyte [8].