Endometriose und Infertilität

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Endometriosis is a common fertility barrier influenced by immunological and mechanical factors, but its impact on assisted reproductive technology success remains debated despite ART advancements.

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This paper reviews how endometriosis can act as a fertility barrier, attributing impaired reproductive outcomes to both immunological factors and local mechanical alterations, and discusses how assisted reproductive technologies (ART) have generated detailed observations across folliculogenesis, fertilization, embryo morphology, and implantation. It highlights ongoing controversy about whether endometriosis remains a major limiting factor for ART success despite advances in reproductive medicine, with the review focusing on IVF- and ART-related pregnancy outcomes. A key caveat explicitly acknowledged is that debate persists and the question of endometriosis’s true impact on reproductive medicine outcomes remains unresolved. This paper is centrally about endometriosis — specifically, it focuses on endometriosis and infertility and the implications for ART/IVF outcomes.

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Abstract

Endometriosis seems to be a common fertility barrier which is affected by immunological and local mechanical factors. The established use of assisted reproductive technologies (ART) provides increasing knowledge about folliculogenesis, fertilization, embryo development and pregnancy rates. Nevertheless, controversial discussion about the success of ART in endometriosis exists although the progress of reproductive technologies is improving constantly in many ways. Despite all discussions the question remains still to be unanswered, whether or not endometriosis is indeed limiting the success in reproductive medicine.
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Subscribe to RSS DOI: 10.1055/s-2005-836866 © Georg Thieme Verlag Stuttgart · New York Endometriose und Infertilität Endometriosis and InfertilityPublication History Publication Date: 29 September 2005 (online) Zusammenfassung Endometriose stellt häufig ein Fertilitätshindernis dar. Einerseits werden immunologische Faktoren, anderseits lokale mechanische Veränderungen dafür verantwortlich gemacht. Durch den etablierten Einsatz der Methoden der assistierten Reproduktion (ART) wurden Einblicke in der Follikulogenese, Fertilisation, Embryomorphologie und Implantation bei Endometriosepatientinnen gewonnen. Weiterhin kontrovers diskutiert wird, ob die Endometriose heutzutage noch immer ein schwerwiegendes Fertilitätshindernis mit geringen Erfolgsaussichten darstellt, trotz Weiterentwicklung der Methoden der assistierten Reproduktionsmedizin. Abstract Endometriosis seems to be a common fertility barrier which is affected by immunological and local mechanical factors. The established use of assisted reproductive technologies (ART) provides increasing knowledge about folliculogensesis, fertilization, embryo development and pregnancy rates. Nevertheless, controversial discussion about the success of ART in endometriosis exists although the progress of reproductive technologies is improving constantly in many ways. Despite all discussions the question remains still to be unanswered, whether or not endometriosis is indeed limiting the success in reproductive medicine. Schlüsselwörter Endometriose - assistierte Reproduktionsmedizin - In-vitro-Fertilisation (IVF) - Schwangerschaftsrate Key words endometriosis - assisted reproductive technology (ART) - in-vitro-fertilization (IVF) - pregnancy rate Literatur - 1 Al-Azemi M, Bernal A L, Steele J, Gramsbergen I, Barlow D, Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod. 2000; 15 72-75 - 2 Barnhart K, Dunsmoor S R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002; 77 1148-1155 - 3 Barabe S, Marcoux S, Langevin M, Maheux R. and the Canadian Collaborative Group of Endometriosis . Fecundity of infertile women with minimal or mild endometriosis and women with unexplained infertility. Fertil Steril. 1998; 69 1034-1041 - 4 Burns W N, Schenken R S. Pathophysiology of endometriosis-associated infertility. Clin Obstet Gynecol. 1999; 42 586-610 - 5 D'Hooghe T, Debrock S, Hill J A, Meuleman C. Endometriosis and subfertility: Is the relationship resolved?. Seminars in Reproductive Medicine. 2003; 21 243-254 - 6 Diaz I, Navarro J, Blasco L, Simon C, Pellicer A, Remohi J. Impact of stage III-IV endometriosis on recipients of sibling oocytes: matched case-control study. Fertil Steril. 2000; 74 31-34 - 7 Dicker D, Goldman J A, Levy T, Feldberg D, Ashkenazi J. The impact of long-term gonadotropin-releasing hormone analogue treatment on preclinical abortions in patients with severe endometriosis undergoing in in-vitro fertilization-embryo transfer. Fertil Steril. 1992; 57 597-600 - 8 DIR Jahrbuch 2003. www.deutsches-ivf-register.de - 9 Evers J L. Female subfertility. Lancet. 2002; 360 151-159 - 10 Geber S, Paraschos T, Atkinson G, Margara R, Winston R M. Results of IVF in patients with endometriosis: the severity of the disease does not affect outcome or the incidence of miscarriage. Hum Reprod. 1995; 10 1507-1511 - 11 Greb R. Ovarielle Stimulation und intrauterine Insemination (COH-IUI) Sinnvolle Therapie bei endometrioseassoziierter Sterilität?. In: Gynäkologische Endokrinologie, Springer Verlag. Online publiziert 6. Oktober 2004 - 12 Hughes E G. The effectiveness of ovulation of persistent infertility: a metaanalysis. Hum Reprod. 1997; 12 1865-1872 - 13 Iha P, Farooy A, Agarwal N, Buckshee K. 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Hum Reprod. 1999; 14 698-703 - 19 Pritts E A, Taylor R N. An evidence-based evaluation of endometriosis-associated infertility. Endocrinol Metabol Clin N Am. 2003; 32 653-667 - 20 Saito H, Seno T, Kaneko T, Nakanara K, Toga M, Karachi H. Endometriosis and oocyte quality. Gynecol Obstet Invest. 2002; 53 (Suppl 1) 46-51 - 21 Schweppe K W. Endometriose: Was tun - und wann? Frühere Diagnose, bessere Differentialdiagnose und individuelle Behandlung. Frauenarzt. 2003; 44 739-744 - 22 Tan S L, Maconochie N, Doyle P, Campbell S, Balen A, Bekir J, Brinsden P, Edwards R G, Jacobs H S. Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short and ultrashort regimes of the gonadropin-releasing hormone agonist buserelin. Am J Obstet Gyn. 1994; 171 513-520 - 23 Tummon I S, Asker L J, Martin I S, Tulandi T. Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis. Fertil Steril. 1997; 68 8-12 - 24 Turmergen Göker E N, Özcakir A T, Terek M C, Levi R, Adokan S, Tarmergen E. Controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis: a retrospective analysis. Arch Gynecol Obstet. 2002; 266 21-24 - 25 der Wat J Van. Endometriosis: the challenge of our time. The Specialist Forum. 2004; 8 35-40 - 26 Vercammen E E, D'Hoogh T M. Endometriosis and recurrent pregnancy loss. Semin Reprod Med. 2000; 18 363-368 - 27 Wardle P G, Foster P A, Mitchell J D, McLaughlin E A, Sykes J A, Corrigan E, Hull M G, Ray B D, McDermott A. Endometriosis and IVF: effect of prior therapy. Lancet. 1986; 1 276-277 - 28 Wheeler H M. Epidemiology of endometriosis-associated infertility. J Reprod Med. 1989; 34 41-46 - 29 Witz C A, Burns W N. Endometriosis and infertility: Is there a cause and effect relationship?. Gynecol Obstet Invest. 2002; 53 (Suppl 1) 2-11 - 30 Yanushpolsky E H, Best C L, Jackson K V, Clarke R N, Barbieri R L, Hornstein M D. Effects of endometriosis on oocyte quality, embryo quality and pregnancy rates in in-vitro fertilization cycles: a prospective, case-controlled study. J Assist Reprod Genet. 1998; 15 193-197 - 31 Zikopoulos K, Kolibianakis E M, Devroy P. Ovarian stimulation for in vitro fertilization in patients with endometriosis. Acta Obstet Gynecol Scand. 2004; 83 651-655 Dr. med. Konstantin Manolopoulos Universitäts-Frauenklinik Gießen Klinikstr. 32 35390 Gießen Phone: 0641/9 94 52 00 Fax: 0641/9 94 51 09 Email: [email protected]

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Infertility, Female Endometriosis Female Fertilization Humans Infertility, Female Pregnancy Reproductive Techniques, Assisted

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