In situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas: A randomized controlled trial

Objective: To evaluate prospectively the efficacy and safety of in situ methotrexate injection after transvaginal ultrasound-guided aspiration of ovarian endometriomas in well selected patients. Design: Randomized controlled trial. Setting: El-Menya infertility research and treatment center (MIRTC), Egypt. Patients: Two hundred and ten patients complaining of symptomatic ovarian endometriomas during reproductive age. Method: Transvaginal ultrasound aspiration (group I) versus aspiration and in situ methotrexate injection (group II). Results: Of 210 patients, 188 patients were available for follow-up; malignant cells were not found in any of them. The overall success rate after complete follow up was 54.73% in group I versus 86.02% in group II, among those patients 25 patients (26.3%) needed single aspiration, 14 patients (14.7%) needed two aspiration, and 13 patients (13.6%) needed three aspiration in study group I versus 62 patients (66.6%) needed single injection, 11 patients (11.8%) needed two injections and 7 patients (7.5%) needed three injections in group II which represented statistically significant difference (P < 0.05). The cyst size and volume of fluid aspirated were statistically significant factors in the resolution of the cyst (P < 0.05), while patients age was not. Conclusions: Transvaginal ultrasound-guided aspiration and in situ methotrexate injection is simple, safe, non-invasive and effective in the treatment of selected cases of ovarian endometriomas with much acceptability among patients.

Abstract licence: CC BY

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