Spontaneous Pregnancy After Laparoscopic Treatment of Ovarian Endometrioma: A Retrospective Cohort Study Comparing Stripping and Ethanol Sclerotherapy

Ovarian endometrioma is associated with infertility, whereas its treatment may compromise ovarian reserve. This retrospective cohort evaluated factors associated with spontaneous pregnancy after laparoscopic treatment of ovarian endometrioma, with particular attention to the Endometriosis Fertility Index (EFI) and reproductive outcomes after cystectomy using the stripping technique vs ethanol sclerotherapy. Forty-eight infertile women with histologically confirmed ovarian endometrioma and revised American Society for Reproductive Medicine stage III-IV endometriosis underwent laparoscopic treatment between 2022 and 2024 in Kinshasa, Democratic Republic of the Congo, with follow-up through June 2026; 33 underwent cystectomy, and 15 underwent ethanol sclerotherapy. Overall, 29/48 women (60.4%) had primary infertility, 30/48 (62.5%) had bilateral endometriomas, and 29/48 (60.4%) had stage IV disease. Spontaneous pregnancy occurred in 17/48 women (35.4%), and 11/48 (22.9%) achieved a live birth. Pregnancy occurred in 9/15 women (60.0%) after sclerotherapy vs 8/33 (24.2%) after cystectomy (p = 0.024). Among women with EFI ≥7, 15/26 (57.7%) conceived, compared with 2/22 (9.1%) with EFI <7 (p < 0.001). In the adjusted Cox model, EFI ≥7 (adjusted hazard ratio (aHR) 7.96, 95% confidence interval (CI) 1.78-35.57; p = 0.007) and ethanol sclerotherapy (aHR 3.11, 95% CI 1.17-8.29; p = 0.023) were associated with a higher rate of spontaneous pregnancy. Both ovarian-reserve markers improved in 15/15 women (100.0%) after sclerotherapy vs 9/33 (27.3%) after cystectomy (p < 0.001). These findings suggest that a favorable EFI identifies women with a higher likelihood of spontaneous pregnancy and that ethanol sclerotherapy may offer reproductive advantages over cystectomy; however, the retrospective design, small sample, and nonrandomized treatment allocation limit causal inference.