Ovarielle Stimulation und intrauterine Insemination (COH-IUI)

Zusammenfassung Die genauen Mechanismen und das Ausmaß der Fertilitätsminderung bei geringgradig ausgeprägter Endometriose bleiben weitgehend unklar. Vor dem Hintergrund einer durchschnittlichen Spontanschwangerschaftsrate von knapp 30% in 6 Monaten in diesem Patientinnenkollektiv stellt sich die Frage einer Aufwand-Nutzen-Risiko-Abschätzung der Anwendung unterschiedlicher Methoden der assistierten Reproduktion. Wenn bestimmte Voraussetzungen erfüllt sind, kann aber mittels ovarieller Stimulation in Verbindung mit intrauterinen Inseminationen (COH-IUI) über eine limitierte Anzahl von Behandlungszyklen eine 3- bis 5fache Erhöhung der monatlichen Fruchtbarkeitsrate (MFR) bei vorliegender Endometriose erzielt werden. Im Vergleich zu Paaren mit idiopathischer Sterilität sind die Chancen für eine mittels COH-IUI herbeigeführte Schwangerschaft allerdings um ungefähr die Hälfte reduziert. Der Stellenwert der COH-IUI und Entscheidungswege für die Indikation auch anderer Methoden der Sterilitätsbehandlung bei endometrioseassoziierter Sterilität sind in einem Algorithmus dargestellt. Abstract The exact mechanisms and the extent of impairment of fertility associated with low-grade endometriosis remain to a large extent unclear. Considering an average spontaneous pregnancy rate of about 30% during 6 months for these patients, expenses, benefits, and risks must be taken into account for choosing the most appropriate method of assisted reproduction for infertility treatment. Under certain conditions a three- to fivefold increase of the monthly fecundity rate (MFR) can be achieved in the presence of endometriosis by controlled ovarian hyperstimulation and intrauterine insemination (COH IUI) over a limited number of treatment cycles. Compared with couples suffering from unexplained infertility, the probability to achieve a pregnancy by COH-IUI is nevertheless reduced in endometriosis patients by approximately 50%. The significance of COH-IUI and a decision pathway for the indication of a COH-IUI and other methods to treat infertility associated with endometriosis are presented as an algorithm. Similar content being viewed by others Literatur Adamson GD, Pasta DJ (1994) Surgical treatment of endometriosis-associated infertility: meta-analysis compared with survival analysis. Am J Obstet Gynecol 171:1488–1504 Anaf V, El N I, Simon P et al. (2000) Sigmoid endometriosis and ovarian stimulation. Hum Reprod 15:790–794 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. 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Hum Reprod 11:1779–1807 Tummon IS, Asher LJ, Martin JS, Tulandi T (1997) Randomized controlled trial of superovulation and insemination for infertility associated with minimal or mild endometriosis. Fertil Steril 68:8–12 Interessenkonflikt: Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Greb, R. Ovarielle Stimulation und intrauterine Insemination (COH-IUI). Gynäkologische Endokrinologie 2, 194–200 (2004). https://doi.org/10.1007/s10304-004-0083-4 Issue date: DOI: https://doi.org/10.1007/s10304-004-0083-4 Schlüsselwörter - Ovarielle Stimulation - Intrauterine Insemination - Monatliche Fruchtbarkeitsrate - Gonadotropine - Behandlungsalgorithmus