Is Ethanol Sclerotherapy the Fertility-Friendly Answer for Endometriomas?

If you live with endometriosis, especially ovarian endometriomas (“chocolate cysts”), you know the constant worry: pain, unpredictable periods, and, above all, protecting your future fertility. For years, the standard answer has been surgery—usually a cystectomy (removing the cyst from your ovary). But what if there were a less invasive option that helped control your pain without putting your eggs and ovarian reserve at risk?

That’s where ethanol sclerotherapy comes in—a minimally invasive treatment that could help relieve your symptoms while still keeping your options open for pregnancy later on. Here’s what you need to know, based on the latest research and real-world results.

What Is Ethanol Sclerotherapy—And How Does It Work?

Ethanol sclerotherapy is a simple, outpatient procedure. Instead of cutting the cyst out, your doctor uses ultrasound to guide a needle into the endometrioma, drains the fluid, and then flushes the cyst with medical-grade ethanol (alcohol). The ethanol irritates the cyst lining so it collapses and scars down—hopefully closing off the “pocket” where endometriosis keeps coming back, but without cutting into surrounding healthy ovarian tissue.

For many, this takes less than an hour. Most people go home the same day—no long hospital stay or slow recovery like with major surgery.

Does It Actually Work...and How Well?

Here are the facts that matter:

• Success Rate: About 95–98% of ethanol sclerotherapy procedures go as planned, with very few major complications reported.
• Ovarian Reserve: Unlike traditional cyst removal, this approach is much gentler on the ovary itself. That means a lower risk of harming your egg count or triggering early menopause. For women hoping to get pregnant—now, or someday—this is a big deal.
• Pain Relief: Many women notice relief from endometrioma-related pain after the procedure, though not everyone gets complete pain control forever.
• Recurrence: Here’s the catch—cysts can come back. Recurrence rates depend on several factors, including how long the ethanol is left in and how the procedure is performed, but recurrence rates are generally higher than with surgical cyst removal. Talk with your doctor about exactly what you can expect based on your cyst’s size, your past treatments, and their experience.

What About Pregnancy—Will This Protect Your Fertility?

If preserving your ability to conceive is your main goal, the research is encouraging. Studies show that most women maintain their ovarian reserve after ethanol sclerotherapy, and some research even suggests a higher egg yield in IVF cycles compared with women who’ve had cysts surgically removed. Pregnancy rates after the procedure look at least as good as those after surgery, but bear in mind: most of this data comes from small studies, and long-term results aren’t fully known.

Side Effects and Downsides: What Should You Watch For?

Ethanol sclerotherapy is considered safe for most women. The risks of heavy bleeding, infection, or losing the ovary are much lower than with surgery, although that is already low with an expert surgeon. However, no procedure is risk-free. Some women have temporary discomfort or pain at the procedure site. There is still a risk of the cyst returning, so you may need repeat treatments or additional monitoring over time. Also, if the ethanol spills into the pelvic cavity, it is intensely irritating and inflammatory and can cause a lot of pain. Then scarring can develop, which leads to chronic pain. So, this is the veritable "double edged sword."

Ethanol sclerotherapy isn’t recommended for every endometrioma. Certain cysts are better suited for this than others, and your personal medical history, pain level, and fertility plans all need to be factored in.

Is This Right for You? Who Should Consider It

You might want to ask about ethanol sclerotherapy if:

• You want to protect your ovarian reserve (number of eggs) as much as possible
• You wish to avoid a bigger surgery and a longer recovery
• Your endometrioma(s) are causing pain, pressure, or making fertility treatment more complicated
• You or your doctor are concerned about losing healthy ovarian tissue during cyst removal

Ethanol sclerotherapy isn’t always a cure-all, and it may not be the best fit if your cyst is unusually large, has suspicious features, or you have other complex health problems.

What to Ask Your Doctor Before Deciding

• Is my endometrioma suitable for ethanol sclerotherapy?
• What are the chances my cyst will come back after this procedure?
• How often will I need monitoring or repeat treatment?
• What are the specific risks for my case—should I be worried about infection or damage to my ovary?
• How soon can I try for pregnancy after this?
• Are there other options (like hormonal management or supportive care) that might fit my goals better?

What Should You Expect—Timeline and Monitoring

Most women recover quickly, often returning to normal life within a day or two. Some mild cramping or spotting is possible. You’ll likely need a follow-up ultrasound in the weeks after your procedure to make sure the cyst is gone (or has shrunk). If your main goal is pregnancy, your doctor may recommend tracking your ovaries through blood tests like anti-Müllerian Hormone (AMH) or antral follicle count (AFC) to be sure your eggs are still protected. These tests are not perfect but provide a general barometer of ovarian reserve.

Recurrence usually happens within the first year or two. The earlier you and your doctor spot it, the more options you’ll have for managing it—so don’t skip aftercare.

The Reality Check: What We Still Don’t Know

Here’s the honest truth: ethanol sclerotherapy shows real promise for preserving fertility, but most evidence comes from small, observational studies. It looks safe and effective short-term, especially for women wanting to avoid surgery, but we just don’t have enough data yet to know who will benefit most, how long results last, or how it compares to other nonsurgical options in the long run. Individual results do vary—a lot-- and it is possible that if intense scarring results, surgery is that much more complicated down the line. Also, one immutable fact has to be top of mind. The chances of having an isolated endometrioma and no additional pelvic endometriosis is fleetingly small. So, this only treats one, potentially small, part of the problem.

It’s not a one-size-fits-all answer. The best plan is the one that fits your life, your pain, your future family plans, and your body.