Der Gynäkologe

, Volume 43, Issue 11, pp 925–930 | Cite as

Sterilitätstherapie bei Endometriose

Im Fokus: assistierte Reproduktion
Leitthema

Zusammenfassung

Viele Sterilitätspatientinnen leiden über einen langen Zeitraum unter einer Endometriose, bevor sie in der Kinderwunschambulanz vorstellig werden. Während operative Maßnahmen ihren klaren Stellenwert haben, ist die medikamentöse Therapie vor oder während einer Kinderwunschbehandlung derzeit nicht standardisiert. Im Vergleich zu einem ausschließlich exspektativem Vorgehen scheinen Maßnahmen der künstlichen Befruchtung bei Endometriosepatientinnen einen Vorteil zu bieten, allerdings sind die Erfolgsaussichten insbesondere im Vergleich zu Patientinnen mit einer alleinigen tubaren oder idiopathischen Sterilität geringer. Die Schwangerschaftsraten der IVF/ICSI (In-vitro-Fertilisation/intrazytoplasmatische Spermieninjektion)-Behandlung sind dabei durchaus abhängig vom Stadium der Endometriose. Ultralange Stimulationsprotokolle mit einer Downregulation über 3 bis 6 Monate scheinen einen gewissen Vorteil gegenüber einem standardisierten Lutealphasenprotokoll aufzuweisen, jedoch ist hier die Datenlage noch nicht ausreichend.

Schlüsselwörter

Endometriose In-vitro-Fertilisation Infertilität 

Infertility treatment and endometriosis

Focus on assisted reproductive techniques

Abstract

Infertility patients suffer from endometriosis for a long time before realising their childlessness. In this case, surgical procedures have shown some benefits, whereas medical treatment before and during assisted reproduction is part of ongoing research. Although assisted reproduction seems to be superior to observation only, the pregnancy rate after IVF in patients with endometriosis is lower than in patients with tubal or idiopathic infertility. However, the grade of endometriosis correlates with the pregnancy rates. Ultra-long stimulation protocols for 3–6 months have shown some advantages as compared to standard long luteal phase regimens, but data are incomplete so far.

Keywords

Endometriosis In vitro fertilisation Infertility 

Literatur

  1. 1.
    Giudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799CrossRefPubMedGoogle Scholar
  2. 2.
    Berube S, Marcoux S, Maheux R (1998) Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian Collaborative Group on Endometriosis. Epidemiology Cambridge/MASS 9(5):504–510Google Scholar
  3. 3.
    Eskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24(2):235–258CrossRefPubMedGoogle Scholar
  4. 4.
    Bayer SR, Seibel MM, Saffan DS et al (1988) Efficacy of danazol treatment for minimal endometriosis in infertile women. A prospective, randomized study. J Reprod Med 33(2):179–183PubMedGoogle Scholar
  5. 5.
    Telimaa S (1988) Danazol and medroxyprogesterone acetate inefficacious in the treatment of infertility in endometriosis. Fertil Steril 50(6):872–875PubMedGoogle Scholar
  6. 6.
    Kauppila A, Telimaa S, Ronnberg L, Vuori J (1988) Placebo-controlled study on serum concentrations of CA-125 before and after treatment of endometriosis with danazol or high-dose medroxyprogesterone acetate alone or after surgery. Fertil Steril 49(1):37–41PubMedGoogle Scholar
  7. 7.
    Fedele L, Parazzini F, Radici E et al (1992) Buserelin acetate versus expectant management in the treatment of infertility associated with minimal or mild endometriosis: a randomized clinical trial. Am J Obstet Gynecol 166(5):1345–1350PubMedGoogle Scholar
  8. 8.
    Thomas EJ, Cooke ID (1987) Successful treatment of asymptomatic endometriosis: does it benefit infertile women? Br Med J (Clin Res Ed) 294(6580):1117–1119CrossRefGoogle Scholar
  9. 9.
    Dmowski WP, Pry M, Ding J, Rana N (2002) Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer. Fertil Steril 78(4):750–756CrossRefPubMedGoogle Scholar
  10. 10.
    FitzSimmons J, Stahl R, Gocial B, Shapiro SS (1987) Spontaneous abortion and endometriosis. Fertil Steril 47(4):696–698PubMedGoogle Scholar
  11. 11.
    Ding GL, Chen XJ, Luo Q et al (2010) Attenuated oocyte fertilization and embryo development associated with altered growth factor/signal transduction induced by endometriotic peritoneal fluid. Fertil Steril 93(8):2538–2544CrossRefPubMedGoogle Scholar
  12. 12.
    Hughes EG (1997) The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis. Hum Reprod 12(9):1865–1872CrossRefPubMedGoogle Scholar
  13. 13.
    Omland AK, Tanbo T, Dale PO, Abyholm T (1998) Artificial insemination by husband in unexplained infertility compared with infertility associated with peritoneal endometriosis. Hum Reprod 13(9):2602–2605CrossRefPubMedGoogle Scholar
  14. 14.
    Deaton JL, Gibson M, Blackmer KM et al (1990) A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 54(6):1083–1088PubMedGoogle Scholar
  15. 15.
    Tummon IS, Asher LJ, Martin JS, Tulandi T (1997) Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis. Fertil Steril 68(1):8–12CrossRefPubMedGoogle Scholar
  16. 16.
    Rickes D, Nickel I, Kropf S, Kleinstein J (2002) Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril 78(4):757–762CrossRefPubMedGoogle Scholar
  17. 17.
    Matorras R, Corcostegui B, Esteban J et al (2010) Fertility in women with minimal endometriosis compared with normal women was assessed by means of a donor insemination program in unstimulated cycles. Am J Obstet GynecolGoogle Scholar
  18. 18.
    Pagidas K, Falcone T, Hemmings R, Miron P (1996) Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer. Fertil Steril 65(4):791–795PubMedGoogle Scholar
  19. 19.
    Sallam HN, Garcia-Velasco JA, Dias S, Arici A (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev (1):CD004635Google Scholar
  20. 20.
    Wu MY, Ho HN (2003) The role of cytokines in endometriosis. Am J Reprod Immunol 49(5):285–296CrossRefPubMedGoogle Scholar
  21. 21.
    Simon C, Gutierrez A, Vidal A et al (1994) Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod 9(4):725–729PubMedGoogle Scholar
  22. 22.
    Leyendecker G, Kunz G, Wildt L et al (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility. Hum Reprod 11(7):1542–1551PubMedGoogle Scholar
  23. 23.
    Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77(6):1148–1155CrossRefPubMedGoogle Scholar
  24. 24.
    Kennedy S, Bergqvist A, Chapron C et al (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698–2704CrossRefPubMedGoogle Scholar
  25. 25.
    Kubota T, Ishi K, Takeuchi H (1997) A study of tubo-ovarian and ovarian abscesses, with a focus on cases with endometrioma. J Obstet Gynaecol Res 23(5):421–426PubMedGoogle Scholar
  26. 26.
    Isaacs JD Jr, Hines RS, Sopelak VM, Cowan BD (1997) Ovarian endometriomas do not adversely affect pregnancy success following treatment with in vitro fertilization. J Assist Reprod Genet 14(10):551–553CrossRefPubMedGoogle Scholar
  27. 27.
    Tinkanen H, Kujansuu E (2000) In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand 79(2):119–122CrossRefPubMedGoogle Scholar
  28. 28.
    Garcia-Velasco JA, Somigliana E (2009) Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 24(3):496–501CrossRefPubMedGoogle Scholar
  29. 29.
    Carvalho BR de, Rosa ESAC, Rosa ESJC et al (2010) Increased basal FSH levels as predictors of low-quality follicles in infertile women with endometriosis. Int J Gynaecol Obstet 110(3):208–212CrossRefPubMedGoogle Scholar
  30. 30.
    Surrey ES, Silverberg KM, Surrey MW, Schoolcraft WB (2002) Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis. Fertil Steril 78(4):699–704CrossRefPubMedGoogle Scholar
  31. 31.
    Chedid S, Camus M, Smitz J et al (1995) Comparison among different ovarian stimulation regimens for assisted procreation procedures in patients with endometriosis. Hum Reprod 10(9):2406–2411PubMedGoogle Scholar
  32. 32.
    Fabregues F, Balasch J, Creus M et al (1998) Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program. Fertil Steril 70(1):46–51CrossRefPubMedGoogle Scholar
  33. 33.
    D’Hooghe TM, Denys B, Spiessens C et al (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86(2):283–290CrossRefGoogle Scholar
  34. 34.
    Stephansson O, Kieler H, Granath F, Falconer H (2009) Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome. Hum Reprod 24(9):2341–2347CrossRefPubMedGoogle Scholar
  35. 35.
    Marcoux S, Maheux R, Berube S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337(4):217–222CrossRefPubMedGoogle Scholar
  36. 36.
    Kodama H, Fukuda J, Karube H et al (1996) Benefit of in vitro fertilization treatment for endometriosis-associated infertility. Fertil Steril 66(6):974–979PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Gynäkologische Endokrinologie und FertilitätsstörungenHeidelbergDeutschland
  2. 2.Kinderwunschzentrum HeidelbergHeidelbergDeutschland

Personalised recommendations