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Objective:
To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with large ovarian endometriomas (>8 cm).

Materials and Methods:
In this retrospective study, 40 participants (mean age, 30.75 years; range, 20–45 years) who underwent CDS for ovarian endometrioma from March 2015 to January 2022 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1 and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test.

Results:
Mean endometrioma size decreased from 9.1 ± 1 cm to 4.4 ± 1.3 cm (p = 0.017). Pain was relieved in all participants, with a decrease in serum CA-125 level (p = .001). There was no difference in serum AMH level before and 1 month after CDS, indicating well-preserved ovarian function (3.7 ± 2.1 ng/mL vs 3.5 ± 2.5 ng/mL respectively; p = 796). There were no procedure-related complications.

Conclusion:
Catheter-directed sclerotherapy resulted in good clinical outcomes and ovarian function was well-preserved in patients with large endometriomas.