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Ovarielle Stimulation und intrauterine Insemination (COH-IUI)

Sinnvolle Therapie bei endometrioseassoziierter Sterilität?

Controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI)

Reasonable approach for infertile patients with endometriosis?

Zusammenfassung

Die genauen Mechanismen und das Ausmaß der Fertilitätsminderung bei geringgradig ausgeprägter Endometriose bleiben weitgehend unklar. Vor dem Hintergrund einer durchschnittlichen Spontanschwangerschaftsrate von knapp 30% in 6 Monaten in diesem Patientinnenkollektiv stellt sich die Frage einer Aufwand-Nutzen-Risiko-Abschätzung der Anwendung unterschiedlicher Methoden der assistierten Reproduktion. Wenn bestimmte Voraussetzungen erfüllt sind, kann aber mittels ovarieller Stimulation in Verbindung mit intrauterinen Inseminationen (COH-IUI) über eine limitierte Anzahl von Behandlungszyklen eine 3- bis 5fache Erhöhung der monatlichen Fruchtbarkeitsrate (MFR) bei vorliegender Endometriose erzielt werden. Im Vergleich zu Paaren mit idiopathischer Sterilität sind die Chancen für eine mittels COH-IUI herbeigeführte Schwangerschaft allerdings um ungefähr die Hälfte reduziert. Der Stellenwert der COH-IUI und Entscheidungswege für die Indikation auch anderer Methoden der Sterilitätsbehandlung bei endometrioseassoziierter Sterilität sind in einem Algorithmus dargestellt.

Abstract

The exact mechanisms and the extent of impairment of fertility associated with low-grade endometriosis remain to a large extent unclear. Considering an average spontaneous pregnancy rate of about 30% during 6 months for these patients, expenses, benefits, and risks must be taken into account for choosing the most appropriate method of assisted reproduction for infertility treatment. Under certain conditions a three- to fivefold increase of the monthly fecundity rate (MFR) can be achieved in the presence of endometriosis by controlled ovarian hyperstimulation and intrauterine insemination (COH IUI) over a limited number of treatment cycles. Compared with couples suffering from unexplained infertility, the probability to achieve a pregnancy by COH-IUI is nevertheless reduced in endometriosis patients by approximately 50%. The significance of COH-IUI and a decision pathway for the indication of a COH-IUI and other methods to treat infertility associated with endometriosis are presented as an algorithm.

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Greb, R. Ovarielle Stimulation und intrauterine Insemination (COH-IUI). Gynäkologische Endokrinologie 2, 194–200 (2004). https://doi.org/10.1007/s10304-004-0083-4

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Schlüsselwörter

  • Ovarielle Stimulation
  • Intrauterine Insemination
  • Monatliche Fruchtbarkeitsrate
  • Gonadotropine
  • Behandlungsalgorithmus

Keywords

  • Controlled ovarian hyperstimulation
  • Intrauterine insemination
  • Monthly fecundity rate
  • Gonadotropins
  • Treatment algorithm