This medical review examines ethanol sclerotherapy as a modern, less invasive alternative to laparoscopic cystectomy for treating ovarian endometriomas. While surgery is the traditional standard, it often causes iatrogenic damage to healthy tissue and reduces a woman's ovarian reserve. The authors compare ultrasound-guided and laparoscopic sclerotherapy against surgical excision by analyzing factors such as Anti-Müllerian hormone (AMH) levels, recurrence rates, and pregnancy outcomes. The findings suggest that ultrasound-guided sclerotherapy is superior for protecting fertility markers, while laparoscopic sclerotherapy may offer the highest clinical pregnancy rates. Ultimately, the source advocates for personalized treatment plans that balance a patient’s desire for symptom relief with their future reproductive goals.