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Fertilitätsprotektion bei rheumatologischen Erkrankungen

Fertility protection in rheumatological diseases

  • Leitthema
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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Eine ovartoxische Therapie kommt nicht nur bei Malignomen zum Einsatz sondern auch bei schweren Autoimmunerkrankungen (AID). Hier wird v. a. das immunsuppressiv wirksame Cyclophosphamid genutzt. Häufig sind junge Frauen vor Abschluss der Familienplanung betroffen. Da das Langzeitüberleben durch verbesserte Therapiemethoden deutlich gestiegen ist, stellt der Schutz der Ovarialfunktion eine wichtige Maßnahme dar.

In diesem Zusammenhang müssen krankheitsspezifische Risiken bei AID beachtet werden. Am Beispiel des systemischen Lupus erythematodes (SLE) – eine der häufigeren AID und die einzige, für die Daten zum Fertilitätserhalt vorliegen – werden die üblichen Maßnahmen anhand der aktuellen Literatur dargestellt.

Gonadotropin-Releasing-Hormon(GnRH)-Analoga können aufgrund der aktuellen Datenlage allen Patienten empfohlen werden. Eine Kryokonservierung von Ovargewebe ist immer noch experimentell, scheint jedoch vielversprechend und kann mit geringem Risiko und minimaler Zeitverzögerung ebenfalls empfohlen werden. Eine Stimulationstherapie und anschließende Kryokonservierung von Eizellen ist bei Aktivität der Grunderkrankung, insbesondere im Falle des SLE, mit einem erhöhten Risiko einer Exazerbation und thrombembolischen Ereignissen verbunden. Diese Therapieoption sollte daher im Einzelfall abgewogen werden und nur unter engmaschiger Überwachung durch ein interdisziplinäres Team aus Reproduktionsmedizinern und Rheumatologen erfolgen. Eine Kombination der Gabe von GnRH-Analoga mit der Kryokonservierung von Ovargewebe erscheint sinnvoll.

Abstract

Cytotoxic therapy which can harm ovarian function is not only used for malignant diseases but also for severe autoimmune diseases (AID) using mainly the immunosuppressive agent cyclophosphamide. Young women during childbearing age are frequently affected by AID. Due to the significantly improved long-term survival of these patients, preservation of ovarian function is a very important issue.

Disease-specific risks must be taken into consideration when counselling patients with AID for fertility preservation. Systemic lupus erythematosus (SLE) is one of the more common forms of AID and the only AID with existing data on fertility preservation. Therefore the available techniques will be discussed on the basis of SLE.

Gonadotropin releasing hormone (GnRH) analogue treatment during cyclophosphamide therapy has been shown to be effective in patients with AID and can be recommended in almost all situations. Cryopreservation of ovarian tissue is still an experimental approach but seems to be very promising. The risk of the necessary laparoscopic surgery and the delay are justifiable. A stimulation therapy for cryopreservation of oocytes has the risk of an exacerbation of the underlying disease and of thromboembolic complications. Therefore this option should only be recommended in isolated cases and under close monitoring of disease activity by an interdisciplinary team of gynecologists and rheumatologists. Treatment with GnRH analogues and cryopreservation of ovarian tissue seems to be a reasonable combination.

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Authors and Affiliations

  1. Universitäts-Frauenklinik Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland

    M. Henes, S. Hübner & B. Lawrenz

  2. Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum Tübingen, Tübingen, Deutschland

    J.C. Henes, M. Schmalzing & I. Kötter

  3. Abteilung für Innere Medizin II (Onkologie, Hämatologie, Immunologie, Rheumatologie, Pulmologie), Universitätsklinikum Tübingen, Tübingen, Deutschland

    J.C. Henes, M. Schmalzing & I. Kötter

  4. Abteilung Gynäkologische Endokrinologie und Reproduktionsmedizin, Frauenklinik, Inselspital, Bern, Schweiz

    M. von Wolff

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Correspondence to M. Henes.

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Henes, M., Henes, J., Schmalzing, M. et al. Fertilitätsprotektion bei rheumatologischen Erkrankungen. Gynäkologische Endokrinologie 10, 105–109 (2012). https://doi.org/10.1007/s10304-011-0457-3

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