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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. Postprocedural 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.

Objectives: To evaluate predictability of estimation of serum levels of glycodelin A (GdA), insulin growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) at the 4 th week gestation age (GA) for development of early pregnancy loss (EPL) in primigravida with polycystic ovary syndrome (PCOS). Patients & Methods: The study included 45 primigravida PCOS women developed EPL (Study group) and 45 primigravida PCOS women completed the observation period uneventfully (Control group). At the 4 th wk GA, all women underwent clinical examination and pregnancy was assured, then all women gave fasting blood samples for estimation of fasting blood glucose (FBG), serum insulin, GdA, IGF-1 and IGFBP-3. Insulin resistance (IR) was evaluated using the homeostasis model assessment IR (HOMA-IR) score. Results: Study women had significantly higher FBG and HOMA-IR score than control women. Estimated 4-wk GA serum levels of IGF-1 were significantly higher, while serum IGFBP-3 and GdA were significantly lower in study versus control PCOS women. Development of EPL showed positive significant correlation with high FBG, HOMA-IR score and high serum IGF-1 levels, while showed negative significant correlation with serum IGFBP-3 and GdA levels. Statistical analyses defined high serum IGF-1 as significant sensitive predictor, while low serum glycodelin A, IGFBP-1 and FBG as specific predictors for development of EPL, in decreasing order of significance. Conclusion: Low serum GdA and IGFBP-3 levels and high IGF-1 levels estimated at the 4 th wk GA may underlie the development of EPL in pregnant PCOS women. Estimation of three markers as multiple marker panels could predict EPL with high sensitivity and specificity.

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