Endometriose und Infertilität

Zusammenfassung Die Fertilität ist bei Endometriosepatientinnen häufig eingeschränkt. Ursächlich dafür sind Störungen der ovariellen Funktion, der Tuben sowie der endometrialen Rezeptivität. Die Mechanismen, auf denen diese Störungen beruhen, sind vielfältig: Störungen der Follikulogenese, oxidativer Stress, Veränderungen des hormonellen Milieus im Ovar und in der Peritonealflüssigkeit, molekularbiologisch nachgewiesene Veränderungen im eutopen Endometrium. Die klassische medikamentöse Behandlung der Endometriose besteht in der Unterdrückung der zyklischen ovariellen Aktivität und steht somit einer direkten, aktiven Kinderwunschtherapie entgegen. Eine alleinige medikamentöse ovarielle Suppression führt nicht zu einer Verbesserung der Fertilität. Operative Maßnahmen mit Entfernung von Endometrioseherden und Adhäsiolyse zeigen dagegen eine Verbesserung der Schwangerschaftsraten. Im Vergleich zu einer abwartenden Strategie bieten Maßnahmen der künstlichen Befruchtung in allen Stadien der Endometriose einen Vorteil, die Erfolgsaussichten sind aber im Vergleich zu denen bei alleiniger tubarer oder idiopathischer Sterilität niedriger einzustufen. Abstract Reduced fertility is a typical finding in patients with endometriosis. Changes in ovarian function, tubal factors, and, probably, reduced endometrial receptivity are causes for subfertility in these patients. The mechanisms responsible for these changes are multiple: defects in folliculogenesis, oxidative stress, hormonal and inflammatory changes in the ovary and peritoneal fluid, and molecular changes in eutopic endometrium. The classic pharmaceutical therapies suppress ovulation and thereby work against fertility and pregnancy during therapy. This classic therapy also does not improve the chances of fertility in the future. Surgical approaches with destruction of the endometriosis and removal of adhesions improve fertility rates. Compared with a wait-and-see strategy, all assisted reproductive techniques improve the chances for pregnancy in patients with endometriosis; however, these seem to be lower than for those with tubal or idiopathic infertility. Literatur Adamson GD, Hurd SJ, Pasta DJ, Rodriguez BD (1993) Laparoscopic endometriosis treatment: is it better? Fertil Steril 59(1):35–44 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77(6):1148–1155 Beretta P, Franchi M, Ghezzi F et al (1998) Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy vs. drainage and coagulation. Fertil Steril 70(6):1176–1180 Bérubé S, Marcoux S, Maheux R (1998) Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian collaborative group on endometriosis. Epidemiology 9(5):504–510 Chapron C, Vercellini P, Barakat H et al (2002) Management of ovarian endometriomas. Hum Reprod Update 8(6):591–597 Review Demirol A, Guven S, Baykal C, Gurgan T (2006) Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 12(5):639–643 D’Hooghe TM, Denys B, Spiessens C et al (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86(2):283–290 Dmowski WP, Pry M, Ding J, Rana N (2002) Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer. Fertil Steril 78(4):750–756 Fábregues F, Balasch J, Creus M et al (1998) Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program. Fertil Steril 70(1):46–51 Guzick DS, Silliman NP, Adamson GD et al (1997) Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine’s revised classification of endometriosis. Fertil Steril 67(5):822–829 Hughes E, Brown J, Collins JJ et al (2007) Ovulation suppression for endometriosis. Cochrane Database Syst Rev 18(3):CD000155 Review Kao LC, Germeyer A, Tulac S et al (2003) Expression profiling of endometrium from women with endometriosis reveals candidate genes for disease-based implantation failure and infertility. Endocrinology 144(7):2870–2881 Kyama CM, Debrock S, Mwenda JM, D’Hooghe TM (2003) Potential involvement of the immune system in the development of endometriosis. Reprod Biol Endocrinol 1:123 Review Marcoux S, Maheux R, Bérubé S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337(4):217–222 Osuga Y, Koga K, Tsutsumi O et al (2002) Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest 53(Suppl 1):33–39 Review Parazzini F (1999) Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi. Hum Reprod 14(5):1332–1334 Sallam HN, Garcia-Velasco JA, Dias S, Arici A (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 25(1):CD004635 Review Somigliana E, Ragni G, Benedetti F et al (2003) Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum Reprod 18(11):2450–2453 Tavmergen E, Ulukus M, Goker EN (2007) Long-term use of gonadotropin-releasing hormone analogues before IVF in women with endometriosis. Curr Opin Obstet Gynecol 19(3):284–288 Review Thomas EJ, Cooke ID (1987) Successful treatment of asymptomatic endometriosis: does it benefit infertile women? Br Med J (Clin Res Ed) 294(6580):1117–1119 Vessey MP, Villard-Mackintosh L, Painter R (1993) Epidemiology of endometriosis in women attending family planning clinics. BMJ 306(6871):182–184 Interessenkonflikt Der Autor gibt an, dass kein Interessenkonflikt besteht. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Popovici, R. Endometriose und Infertilität. Gynäkologe 42, 43–49 (2009). https://doi.org/10.1007/s00129-008-2319-1 Published: Issue date: DOI: https://doi.org/10.1007/s00129-008-2319-1