Full text
9,429 characters
· extracted from
oa-doi-fallback
· click to expand
Zusammenfassung
Bei einer Patientin mit Endometriose und Kinderwunsch unterscheidet sich das therapeutische Vorgehen von dem bei einer Schmerzpatientin. So ist die endokrine Therapie bei Kinderwunsch keine sinnvolle Option. Eine operative Sanierung muss sorgfältig indiziert werden, da nicht nur die Endometriose, sondern auch der Eingriff selbst ein Risiko für die Fertilität darstellen kann. Nach Leitlinien werden besonders bei Endometriomen und Rezidiveingriffen reproduktionsmedizinische Verfahren als primäre therapeutische Option empfohlen. Neue Perspektiven für Endometriosepatientinnen bieten Maßnahmen der Fertilitätsprotektion, die im individuellen Fall sinnvoll sein können. Diese Übersicht fasst aktuelle Kenntnisse und Empfehlungen im Spannungsfeld Endometriose und Kinderwunsch zusammen. Sie ermutigt zu einer engen Zusammenarbeit zwischen Operateur und Reproduktionsmediziner.
Abstract
In women with endometriosis wishing to conceive, therapeutic strategies can differ significantly from those applied in patients suffering from endometriosis-associated pain. In the case of infertility, endocrine therapy is not an option. The resection of endometriosis needs to be carefully indicated since follicular reserve can be at risk due to the surgical procedure itself. According to recent guidelines, assisted reproductive techniques should be preferred in these cases. New perspectives are offered by measures of fertility preservation that can be beneficial in individual cases of endometriosis. This review summarizes recent knowledge and recommendations available in the field of endometriosis and infertility, encouraging close cooperation between gynecologic surgery and reproductive medicine.
Similar content being viewed by others
Literatur
D’Hooghe TM, Denys B, Spiessens C, Meuleman C, Debrock S (2006) Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 86:283–290. https://doi.org/10.1016/j.fertnstert.2006.01.016
Duffy JM, Arambage K, Correa FJ, Olive D, Farquhar C, Garry R, Barlow DH, Jacobson TZ (2014) Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 4:CD11031. https://doi.org/10.1002/14651858.CD011031.pub2
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 29:400–412. https://doi.org/10.1093/humrep/det457
Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F (1996) Large ovarian endometriomas. Hum Reprod 11:641–646. https://doi.org/10.1093/humrep/11.3.641
Elizur SE, Chian RC, Holzer HEG, Gidoni Y, Tulandi T, Tan SL (2009) Cryopreservation of oocytes in a young woman with severe and symptomatic endometriosis: a new indication for fertility preservation. Fertil Steril 91:293.e1–293.e3. https://doi.org/10.1016/j.fertnstert.2007.06.040
Garrido N, Navarro J, García-Velasco J, Remoh J, Pellice A, Simón C (2002) The endometrium versus embryonic quality in endometriosis-related infertility. Hum Reprod Update 8:95–103. https://doi.org/10.1093/humupd/8.1.95
Georgiou EX, Melo P, Baker PE, Sallam HN, Arici A, Garcia-Velasco JA, Abou-Setta AM, Becker C, Granne IE (2019) Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev 2019(11):CD13240. https://doi.org/10.1002/14651858.CD013240.pub2
Giudice LC, Kao LC (2004) Endometriosis. Lancet 364:1789–1799. https://doi.org/10.1016/S0140-6736(04)17403-5
Hamdan M, Dunselman G, Li TC, Cheong Y (2015) The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update 21:809–825. https://doi.org/10.1093/humupd/dmv035
Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P (2007) Ovulation suppression for endometriosis. Cochrane Database Syst Rev 18:CD155. https://doi.org/10.1002/14651858.CD000155.pub2
Kohl Schwartz A, Imboden S, von Wolff M (2020) Fertilitätsprotektion – Endometriose. In: von Wolff M, Nawroth F (Hrsg) Perspektive Fertilität – Indikation und Durchführung fertilitätsprotektiver Maßnahmen bei onkologischen und nicht-onkologischen Erkrankungen. Schmidt & Klaunig, Kiel, S 168–183
Lyons RA, Djahanbakhch O, Saridogan E, Naftalin AA, Mahmood T, Weekes A, Chenoy R (2002) Peritoneal fluid, endometriosis, and ciliary beat frequency in the human fallopian tube. Lancet 360:1221–1222. https://doi.org/10.1016/S0140-6736(02)11247-5
Macer ML, Taylor HS (2012) Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am 39:535–549. https://doi.org/10.1016/j.ogc.2012.10.002
Marcoux S, Maheux R, Bérubé S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. N Engl J Med 337:217–222. https://doi.org/10.1056/NEJM199707243370401
Moini A, Bahar L, Ashrafinia M, Eslami B, Hosseini R, Ashrafinia N (2012) Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis. Int J Fertil Steril 5:235–240
Parazzini F (1999) Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Hum Reprod 14:1332–1334. https://doi.org/10.1093/humrep/14.5.1332
Practice Committee of the American Society for Reproductive Medicine (2012) Endometriosis and infertility: a committee opinion. Fertil Steril 98:591–598. https://doi.org/10.1016/j.fertnstert.2012.05.031
Raad J, Sonigo C, Tran C, Sifer C, Durnerin IC, Grynberg M (2018) Oocyte vitrification for preserving fertility in patients with endometriosis: first observational cohort study. Eur J Obstet Gynecol Reprod Biol 220:140–141. https://doi.org/10.1016/j.ejogrb.2017.12.001
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 20:217–230. https://doi.org/10.1093/humupd/dmt053
Schüring AN, Dahlhues B, Korte A, Kiesel L, Titze U, Heitkötter B, Ruckert C, Götte M (2018) The endometrial stem cell markers notch‑1 and numb are associated with endometriosis. Reprod Biomed Online 36:294–301. https://doi.org/10.1016/j.rbmo.2017.11.010
Schüring AN, Fehm T, Behringer K, Goeckenjan M, Wimberger P, Henes M, Henes J, Fey MF, von Wolff M (2018) Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part I: Indications for fertility preservation. Arch Gynecol Obstet 297:241–255. https://doi.org/10.1007/s00404-017-4594-3
Simón C, Gutiérrez A, Vidal A, de los Santos MJ, Tarín JJ, Remohí J, Pellicer A (1994) Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod 9:725–729. https://doi.org/10.1093/oxfordjournals.humrep.a138578
Somigliana E, Viganò P, Filippi F, Papaleo E, Benaglia L, Candiani M, Vercellini P (2015) Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod 30:1280–1286. https://doi.org/10.1093/humrep/dev078
Toth B, Baston-Büst DM, Behre HM, Bielfeld A, Bohlmann M, Bühling K, Dittrich R, Goeckenjan M, Hancke K, Kliesch S, Köhn FM, Krüssel J, Kuon R, Liebenthron J, Nawroth F, Nordhoff V, Pinggera GM, Rogenhofer N, Rudnik-Schöneborn S, Schuppe HC, Schüring A, Seifert-Klauss V, Strowitzki T, Tüttelmann F, Vomstein K, Wildt L, Wischmann T, Wunder D, Zschocke J (2019) Diagnosis and therapy before assisted reproductive treatments. Guideline of the DGGG, OEGGG and SGGG (S2k level, AWMF register number 015-085, February 2019)—part 1, basic assessment of the woman. Geburtshilfe Frauenheilkd 79:1278–1292. https://doi.org/10.1055/a-1017-3389
Vercellini P, Matteis S, Somigliana E, Buggio L, Frattaruolo MP, Fedele L (2013) Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 92:8–16. https://doi.org/10.1111/j.1600-0412.2012.01470.x
Vercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG (2006) Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 195:1303–1310. https://doi.org/10.1016/j.ajog.2006.03.068
Vercellini P, Somigliana E, Viganò P, De Matteis S, Barbara G, Fedele L (2009) The effect of second-line surgery on reproductive performance of women with recurrent endometriosis: a systematic review. Acta Obstet Gynecol Scand 88:1074–1082. https://doi.org/10.1080/00016340903214973
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
A. Schüring und L. Kiesel geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Redaktion
L. Kiesel, Münster
W. Janni, Ulm
Rights and permissions
About this article
Cite this article
Schüring, A., Kiesel, L. Endometriose und Kinderwunsch. Gynäkologe 53, 666–670 (2020). https://doi.org/10.1007/s00129-020-04667-3
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1007/s00129-020-04667-3
Text is read by the "Ask this paper" AI Q&A widget below.
Extraction quality varies by source — PMC NXML preserves structure
cleanly, OA-HTML may include some navigation residue, and OA-PDF can
have broken hyphenation. The publisher copy
(via DOI)
is the canonical version.