Background: Ovarian endometrioma (OE) is in women of reproductive age, so its management must consider the preservation of ovarian reserve.
Objectives: This study investigated the effect of ultrasound-guided transvaginal aspiration and retained ethanol sclerotherapy (AEST) on antral follicular count (AFC) and serum levels of tumor necrosis factor-α (TNF-α) and interleukin (IL)-8 and 10.
Patients and methods: Design: Prospective interventional study. 69 women with OE were evaluated clinically and by transvaginal ultrasonography (TUV). AEST procedure was performed and the collected aspirate and pre-procedural blood samples were collected for estimation of cytokines' levels. At 6-m post-procedure, clinical evaluation and TUV were repeated and serum cytokines' levels were re-estimated.
Results: Post-procedural pain scores and diameter of the cyst remnants were significantly decreased. Cyst remnants were still large in 9 patients (13%). Post-procedural AFC was significantly increased, while serum AMH was non-significantly increased. Cystic aspirate cytokines' levels were significantly higher than the pre-and post-procedural serum levels. Post-procedural serum TNF-α and IL-8 levels were significantly decreased by 30.9% and 34.5%, respectively, while serum IL-10 levels were significantly increased by 160%. Statistical analyses defined high TNF-α and low IL-10 in cystic fluid as the predictors for small AFC, while a post-procedure high percentage of decrease in serum IL-8 as the predictor for the presence of post-procedural ≥5 follicles.    
Conclusion: AEST improved ovarian reserve and systemic immune milieu and reduced pain severity in patients who had OE. Sclerotherapy spared the need for surgery and resource.