Clinical Efficacy of Local Methotrexate Injection in the Treatment of Ovarian Endometriomas and Its Effect on Ovarian Reserve: A Comprehensive Analytical Review

Abstract

Preserving ovarian reserve during the treatment of ovarian endometriomas remains the foremost challenge in contemporary reproductive medicine. This study aims to evaluate the feasibility of ultrasound-guided transvaginal aspiration followed by local methotrexate (MTX) injection as a strategic alternative to conventional surgical excision.

Compared with laparoscopic surgery, this approach offers the advantages of reduced anesthetic and surgical complications, as well as economic cost savings.

Through a comprehensive review and analysis of published scientific evidence (1999–2025), the findings demonstrate that local methotrexate injection achieves clinical resolution rates of up to 86.02%, substantially surpassing those of simple aspiration (54.73%). More importantly, the data confirm stability in fertility indicators, including anti-Müllerian hormone (AMH) levels and antral follicle counts (AFC) following the procedure, reflecting the high biological safety of this intervention on underlying primordial follicles.

The study concludes that this protocol represents a fundamental "fertility-neutral" cornerstone, offering clinicians a safe option for patients with recurrent cysts or diminished ovarian response, thereby sparing them the risks of permanent ovarian tissue loss associated with surgery.