Ovarielle Stimulation bei Endometriose und Infertilität

Zusammenfassung Endometriose ist eine der häufigsten gynäkologischen Erkrankungen. Endometriose ist per se mit dem Risiko der Subfertilität behaftet. Entzündliche Reaktionen in einem veränderten peritonealen Milieu und Endometriome/Endometriosezysten schädigen die Ovarien und die Eizellqualität. Die Abortraten sind erhöht. Präzisionschirurgie und Techniken der assistierten Reproduktion (ART; beispielsweise In-vitro-Fertilisation [IVF]/intrazytoplasmatische Spermieninjektion [ICSI]) sind adäquate Strategien zu Behandlung des unerfüllten Kinderwunsches. Um die Chancen auf den Eintritt einer Schwangerschaft zu verbessern, ist die ovarielle Stimulation zur IVF von Bedeutung, um eine ausreichende Anzahl kompetenter Oozyten zu gewinnen. Darüber hinaus ist die ovarielle Stimulation für ein Oocyte-Banking bei jungen Endometriosepatientinnen ohne aktuellen Kinderwunsch notwendig und sollte zu einem kompetenten Behandlungskonzept dazugehören. Abstract Women with endometriosis inherently experience subfertility. Inflammatory reactions in the pelvis and possible severe damage of the ovaries by endometriomas/endometriotic cysts contribute significantly to subfertility and infertility. Miscarriage rates are elevated among women with endometriosis. Precision surgery and assisted reproductive techniques (ART), such as in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), are strategies to treat infertility in these patients. In the context of IVF, ovarian stimulation is crucial to harvest high-quality oocytes, which are prerequisite for successful fertilization and the onset of pregnancy. Furthermore, oocyte banking should be considered an integral part of a comprehensive approach to preserve fertility in young women with endometriosis who are currently not seeking to conceive. Similar content being viewed by others Literatur Nezhat C, Nezhat F, Nezhat C (2012) Endometriosis: ancient disease, ancient treatments. Fertil Steril 98(6 Suppl):S1–S62. https://doi.org/10.1016/j.fertnstert.2012.08.001 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77(6):1148–1155. https://doi.org/10.1016/s0015-0282(02)03112-6 Agic A, Küpker W (2017) Der Kampf mit der Hydra: Endometriose und Infertilität – wie radikal soll man operieren? Gynäkologe 06:2017 Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412. https://doi.org/10.1093/humrep/det457 Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW (2014) Leitlinien Endometriose der DGGG (S2k): Leitlinien zur Diagnostik und Therapie der Endometriose. Long Version – AWMF Nr. 015/045. 8/2013. Geburtshilfe Frauenheilkd 74(12):1104–1118 Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S (2004) A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 82:1633–1637 Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2:CD4992. https://doi.org/10.1002/14651858 Romualdi D, Franco zannoni G, Lanzone A, Selvaggi L, Tagliaferri V, Gaetano Vellone V (2011) Follicular loss in endoscopic surgery for ovarian endometriosis: quantitative and qualitative observations. Fertil Steril 96:374–378 Benschop L, Farquhar C, van der Poel N, Heineman MJ (2010) Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 11:CD8571 Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG (2009) The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 92:75–87 Matalliotakis I, Mahutte NG, Koukoura O, Arici A (2006) Endometriosis-associated stage IA clear cell ovarian carcinoma in a woman with IVF-ET treatments in the Yale series. Arch Gynecol Obstet 274:184–186 Moini A, Riazi K, Amid V, Ashrafi M, Tehraninejad E, Madani T, Owj M (2005) Endometriosis may contribute to oocyte retrieval-induced pelvic inflammatory disease: report of eight cases. J Assist Reprod Genet 22:307–309 Peirce CL, Templeman C, Rossing MA (2012) Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol 13:385–394 (On behalf of the Ovarian cancer Association Consortium) Carrillo L, Seidmann DS, Cittadini E, Meirow D (2016) The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet 33:317–323 Sanchez AM, Viganò P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M (2014) The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update 20(2):217–230. https://doi.org/10.1093/humupd/dmt053 Sanchez AM, Stella Vanni V, Bartiromo L, Papaleo E, Zilberberg E, Candiani M, Orvieto R, Vigano P (2017) Ist he oocyte quality affected by endometriosis ? A review of literature. J Ovarian Res: 10–43 Takeuchi A, Koga K, Satake E, Makabe T, Taguchi A, Miyashita M, Takamura M, Harada M, Hirata T, Hirota Y, Yoshino O, Wada-Hiraike O, Fujii T, Osuga Y (2019) Endometriosis triggers excessive activation of primordial follicles via PI3K-PTEN-Akt-Foxo3 pathway. J Clin Endocrinol Metab 104(11):5547–5554. https://doi.org/10.1210/jc.2019-00281 Gomes FM, Navarro PA, de Abreu LG, Ferriani RA, dos Reis RM, de Moura MD (2008) Effect of peritoneal fluid from patients with minimal/mild endometriosis on progesterone release by human granulosa-lutein cells obtained from infertile patients without endometriosis: a pilot study. Eur J Obstet Gynecol Reprod Biol 138(1):60–65. https://doi.org/10.1016/j.ejogrb.2007.12.008 Thombre Kulkarni M, Shafrir A, Farland LV, Terry KL, Whitcomb BW, Eliassen AH, Bertone-Johnson ER, Missmer SA (2022) Association between laparoscopically confirmed endometriosis and risk of early natural menopause. JAMA Netw Open 5(1):e2144391. https://doi.org/10.1001/jamanetworkopen.2021.44391 Seyhan A, Urman B, Turkgeldi E, Ata B (2018) Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation. Reprod Biomed Online 36(2):239–244. https://doi.org/10.1016/j.rbmo.2017.10.108 Somigliana E, Viganò P, Benaglia L, Busnelli A, Paffoni A, Vercellini P (2019) Ovarian stimulation and endometriosis progression or recurrence: a systematic review. Reprod Biomed Online 38(2):185–194. https://doi.org/10.1016/j.rbmo.2018.11.021 Santulli P, Bourdon M, Presse M, Gayet V, Marcellin L, Prunet C, de Ziegler D, Chapron C (2016) Endometriosis-related infertility: assisted reproductive technology has no adverse impact on pain or quality-of-life scores. Fertil Steril 105(4):978–987.e4. https://doi.org/10.1016/j.fertnstert.2015.12.006 Soliman D, Naoom R, Zaied M, Soliman S (2024) The role of elagolix in ovulation suppression during controlled ovarian stimulation: a retrospective cohort study. F S Rep 5(4):356–362. https://doi.org/10.1016/j.xfre.2024.06.006 Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y (2019) Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update 25(5):592–632. https://doi.org/10.1093/humupd/dmz012 Wu Y, Halverson G, Basir Z, Strawn E, Yan P, Guo SW (2005) Aberrant methylation at HOXA10 may be responsible for its aberrant expression in the endometrium of patients with endometriosis. Am J Obstet Gynecol 193(2):371–380. https://doi.org/10.1016/j.ajog.2005.01.034 Cheng YH, Yin P, Xue Q, Yilmaz B, Dawson MI, Bulun SE (2008) Retinoic acid (RA) regulates 17beta-hydroxysteroid dehydrogenase type 2 expression in endometrium: interaction of RA receptors with specificity protein (SP) 1/SP3 for estradiol metabolism. J Clin Endocrinol Metab 93(5):1915–1923. https://doi.org/10.1210/jc.2007-1536 Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt W. Küpker, J. Aizpurua, A. Agic, L. Beiglböck, K. Diedrich und R.E. Felberbaum geben an, dass kein Interessenkonflikt besteht. Für 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. Additional information Redaktion Klaus Diedrich, Lübeck Sebastian Findeklee, Göttingen Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Küpker, W., Aizpurua, J., Agic, A. et al. Ovarielle Stimulation bei Endometriose und Infertilität. Gynäkologie 58, 493–498 (2025). https://doi.org/10.1007/s00129-025-05392-5 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00129-025-05392-5 Schlüsselwörter - Techniken der assistierten Reproduktion - Entzündliche Reaktionen - Ovulationsinduktion - Gonadotropin-Releasing-Hormon - Hormonantagonisten