{"paper_id":"f5f1da6a-f5d4-4a81-a15a-fbe40af2da2e","body_text":"Zusammenfassung\nNachdem bis zur Jahrtausendwende das „lange Protokoll“ unter Verwendung von GnRH(„gonadotropin releasing hormone“)-Agonisten der Goldstandard in der kontrollierten ovariellen Stimulation war, läutete die Markteinführung peptidischer GnRH-Antagonisten eine neue Ära in der Behandlung ungewollt kinderloser Paare ein. Die Tatsache, dass GnRH-Antagonisten erst dann zum Einsatz kommen, wenn ein vorzeitiger LH(luteinisierendes Hormon)-Surge, also eine vorzeitige Ovulation droht, führte zu einer signifikanten Verkürzung der Stimulationszeit und der notwendigen Menge an zu verabreichenden Gonadotropinen. Außerdem reduzierte diese Behandlungsmodalität das Risiko für ein höhergradiges ovarielles Überstimulationssyndrom (OHSS). Seit den 20er-Jahren dieses Jahrhunderts werden weltweit über 80 % aller Behandlungen entsprechend dem in Bonn und Lübeck entwickelten „multiple dose antagonist protocol“ durchgeführt. Die Einführung der peptidischen GnRH-Antagonisten war ein wirklicher „game changer“. Nun stehen seit der Einführung von Elagolix auf dem US-amerikanischem Markt, und von Relugolix und Linzagolix auf US-amerikanischem und dem europäischem Markt Substanzen zu Verfügung, die als nichtpeptidische GnRH-Antagonisten oral verabreicht werden können. Diese Präparate haben sich in der Behandlung des Uterus myomatosus und der Endometriose etablieren können. Folgerichtig erscheint die kontrollierte ovarielle Stimulation das nächste mögliche Anwendungsgebiet zu sein. Allerdings sind die bisher publizierten Erfahrungen noch spärlich. Es stellt sich die Frage, ob diese neuen „small molecules“ die gleiche Effektivität in der Vermeidung der vorzeitigen Luteinisierung bzw. die gleiche Effizienz in der Behandlung mit den Methoden der assistierten Reproduktion aufweisen können wie die peptidischen Vertreter dieser Substanzgruppe.\nAbstract\nAfter the so-called long protocol using gonadotropin-releasing hormone (GnRH) agonists had been the gold standard in controlled ovarian stimulation until the turn of the millennium, the market launch of peptide GnRH antagonists heralded a new era in the treatment of involuntarily childless couples. The fact that GnRH antagonists are only used when there is a risk of a premature luteinizing hormone (LH) surge, i.e., premature ovulation, led to a significant shortening of the stimulation time and the necessary amount of gonadotropins to be administered. Additionally, this treatment modality reduced the risk of higher-grade ovarian hyperstimulation syndrome (OHSS). Since the 1920s over 80% of all treatments worldwide have been carried out according to the multiple dose antagonist protocol developed in Bonn and Lübeck. The introduction of the peptide GnRH antagonists was a real game changer. Since the introduction of elagolix on the US market, and of relugolix and linzagolix on the US and European markets, substances have become available that can be administered orally as non-peptide GnRH antagonists. These preparations have become established in the treatment of uterine leiomyoma and endometriosis. Consequently, controlled ovarian stimulation appears to be the next possible area of application; however, published experiences to date are still sparse. 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Diedrich geben an, dass kein Interessenkonflikt besteht.\nFür diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.\nAdditional information\nRedaktion\nKlaus Diedrich, Lübeck\nRicardo Felberbaum, Kempten\nKatharina Hancke, Ulm\nWolfgang Küpker, Baden-Baden\nThomas Strowitzki, Heidelberg\nHinweis des Verlags\nDer Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.\nQR-Code scannen & Beitrag online lesen\nRights and permissions\nAbout this article\nCite this article\nFelberbaum, R., Küpker, W. & Diedrich, K. Orale GnRH-Antagonisten in der kontrollierten ovariellen Stimulation: noch viele Fragen offen. Gynäkologie 57, 679–685 (2024). https://doi.org/10.1007/s00129-024-05280-4\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00129-024-05280-4\nSchlüsselwörter\n- Ovarielles Überstimulationssyndrom\n- Fertilität\n- Sterilität\n- In-vitro-Fertilisation\n- Assistierte Reproduktion","source_license":"CC0","license_restricted":false}