Sterilitätstherapie bei Endometriose

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. 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. 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