To evaluate the feasibility and effectiveness of vaginal ethanol sclerotherapy (EST) for ovarian endometriomas, with a focus on recurrence and subsequent fertility outcomes.

We conducted a retrospective study including all patients who underwent vaginal EST at the Strasbourg University Hospitals from January 2015 to March 2024. Diagnosis was based on transvaginal ultrasound, with MRI confirmation in selected cases. The primary endpoint was recurrence, defined as reappearance of an endometrioma >30 mm at least one month after treatment. Secondary outcomes were postoperative complications and fertility outcomes.

Among 129 procedures scheduled, 118 were performed and analyzed. Three cases required conversion to laparoscopy. The mean patient age was 32 years, and 87% had a history of infertility. Endometriomas had a mean diameter of 50 mm; 28% of treated ovaries had a prior surgical history. The recurrence rate was 12.7% (15/118), with a mean time to recurrence of 3 months and mean cyst diameter of 55 mm. Perioperative complications included three alcohol leaks (2.5%) and one hemoperitoneum (0.8%). Postoperative complications occurred in 1.6% of cases, including one infected hematoma and one peritonitis. Among patients desiring pregnancy (n=86), 41.9% conceived, 69.4% of which resulted in live births. Most pregnancies (83.3%) were achieved through assisted reproductive technology.

Vaginal EST appears to be a feasible and safe alternative to cystectomy, with a low recurrence rate and a favorable impact on fertility outcomes. It may represent a promising fertility-preserving option for women with endometriomas and diminished ovarian reserve.