Treatment options for ovarian chocolate cysts include medications [11] and surgical procedures. However, surgical interventions can lead to open wounds and associated complications [12]. UGP intervention is recognized as a viable option for endometriosis therapy with many advantages, including non-interference wound, less invasiveness, and preservation of ovarian function [13, 14]. In this study, we carried out a non-randomized trial of UGP intervention and LC for ovarian cyst treatment. We observed that LC eliminated ovarian cysts and reduced VAS scores to the greatest extent in patients than UGP, consistent with previous studies [15, 16].

The surgery group exhibited more cysts and severe laterality status at baseline. Multivariate regression analysis showed that patients with more cysts and laterality status can benefit more from LC. It is well-established that non-excisional techniques are associated with increased recurrence rates [17]. Our findings revealed that UGP intervention was considerably effective, resulting in few recurrences among patients. The low recurrence rate in the puncture group did not align with previous studies [14, 18], which may be due to the mild cyst status before procedures and the short follow-up period.

Decreased AMH indicated that LC impaired ovarian reserve. AMH levels increased 6 months after UGP. By decompressing the cysts, UGP may mitigate mechanical stress on the ovarian stroma, thus preserving follicular pools. Cyst removal could restore blood flow to adjacent ovarian tissue, enhancing follicular activity. UGP may also reduce inflammatory cytokines that suppress AMH production [19]. Longer-term follow-up is needed to confirm the trends. Although elevated AMH may indicate improved ovarian reserve, its association with reproductive outcomes needs to be further validated. Future studies should consider sinus follicle count (AFC) and fertility endpoints for further validation. CA-125 decreased 6 months after surgery (Table 4) compared with UGP, as it may reflect inflammation, cyst burden, or comorbidities rather than direct treatment effects [20]. CA-125 trends in our cohort should be interpreted in conjunction with imaging and symptom outcomes, rather than as a standalone biomarker.

This non-randomized trial suggests that patients with different clinical manifestations at admission and different therapeutic goals should opt for varied treatment modalities [21].

In this study, we used a non-randomized trial design to evaluate the efficacy of UGP intervention and LC in the treatment of ovarian endometriosis cysts. Although this approach is feasible in practical applications, it also brings some limitations. Importantly, VAS-driven grouping limits causal inference and results are only hypothetical. Reliable research must integrate multidimensional assessments (imaging, biomarkers, and patient goals) to reflect real-world practice and ensure valid conclusions. First, non-randomized grouping may introduce selection bias, thereby compromising the generalizability of the results. For example, significant differences were observed in the number of cysts and laterality status between the surgery and puncture groups. Second, the relatively small sample size constrains the robustness of the statistical analysis, potentially limiting the generalizability of the results. In addition, a follow-up period of 6 months may not be sufficient to fully evaluate the long-term effects and safety of both treatments. The loss of follow-up information for some patients has further affected data integrity and accuracy.

In addition, as this study is conducted at a single center, our conclusions may be influenced by specific healthcare settings, thus limiting their broader applicability. Future studies should employ randomized methods, expand the sample size, ensure consistency and standardization of procedures, and involve multiple centers to improve the generalizability and reliability of the conclusions. Furthermore, it is vital to take steps to ensure the integrity of data collection and further explore the biological mechanisms behind the treatment.

Addressing and overcoming these limitations will enable future investigations to provide a deeper understanding and more effective approaches for clinical practice.