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 Endometriomata/Endometriosezysten schädigen die Ovarien und die Eizellqualität. Die Abortraten sind erhöht. Präzisionschirurgie und ART („assisted reproductive techniques“; IVF/ICSI [In-vitro-Fertilisation/intrazytoplasmatische Spermieninjektion]) sind adäquate Strategien zur Behandlung des unerfüllten Kinderwunsches. Mit einem besseren Verständnis der Pathophysiologie der Erkrankung wird es weniger invasive medikamentöse Therapien in der Zukunft geben. Abstract Endometriosis is one of the most common gynecologic diseases. Women with endometriosis display with subfertility per se. Inflammatory reactions in the pelvis and endometriomas/endometriotic cysts damage the ovaries and reduce the quality of egg cells. Miscarriage rates are elevated. Precision surgery and assisted reproductive techniques (ART; in vitro fertilization/intracytoplasmic sperm injection [IVF/ICSI]) are the predominant therapeutic strategies to improve the chance of conceiving. By better understanding the pathophysiology of endometriosis, less invasive medical treatment options are to be expected in the future. Similar content being viewed by others Notes Küpker W, unveröffentlicht. Adenomyosis and infertility: Does immunology mapping help? Vortrag beim Annual Meeting der Endometriosis Foundation, New York, 2023 Küpker W, unveröffentlicht. Adenomyosis and infertility: Does immunology mapping help? Vortrag beim Annual Meeting der Endometriosis Foundation, New York, 2023. 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 Bulun SE (2009) Endometriosis. N Engl J Med 360(3):268–279. https://doi.org/10.1056/NEJMra0804690 Brosens I, Pijnenborg R, Benagiano G (2013) Defective myometrial spiral artery remodelling as a cause of major obstetrical syndromes in endometriosis and adenomyosis. Placenta 34(2):100–105. https://doi.org/10.1016/j.placenta.2012.11.017 Xue Q, Lin Z, Cheng YH, Huang CC, Marsh E, Yin P, Milad MP, Confino E, Reierstad S, Innes J, Bulun SE (2007) Promoter methylation regulates estrogen receptor 2 in human endometrium and endometriosis. Biol Reprod 77(4):681–687. https://doi.org/10.1095/biolreprod.107.061804 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 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, Vanni SV, Bartiromo L, Papaleo E, Zilberberg E, Candiani M, Orvieto R, Vigano P (2017) Is the 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 Dongye H, Ji X, Ma X, Song J, Yan L (2021) The impact of endometriosis on embryo quality in in-vitro fertilization/Intracytoplasmic sperm injection: a systematic review and meta-analysis. Front Med 8:669342. https://doi.org/10.3389/fmed.2021.669342 Díaz I, Navarro J, Blasco L, Simón C, Pellicer A, Remohí J (2000) Impact of stage III–IV endometriosis on recipients of sibling oocytes: matched case-control study. Fertil Steril 74(1):31–34. https://doi.org/10.1016/s0015-0282(00)00570-7 Du YB, Gao MZ, Shi Y, Sun ZG, Wang J (2013) Endocrine and inflammatory factors and endometriosis-associated infertility in assisted reproduction techniques. Arch Gynecol Obstet 287(1):123–130. https://doi.org/10.1007/s00404-012-2567-0 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 Han B, Liang T, Zhang W, Ma C, Qiao J (2023) The effect of adenomyosis types on clinical outcomes of IVF embryo transfer after ultra-long GnRH agonist protocol. Reprod Biomed Online 46(2):346–351. https://doi.org/10.1016/j.rbmo.2022.09.021 Brosens I, Puttemans P, Campo R et al (2004) Diagnosis of endometriosis : pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol 18:285–303 Medina MG, Lebovic DI (2009) Endometriosis—associated nerve fibers and pain. Acta Obstet Gynecol Scand 88:968–975 Kyama CM, Debrock S, Mwenda JM et al (2003) Potential involvement of the immune system in the development of endometriosis. Reprod Biol Endocrinol 1:121 Redwine DB (1999) Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril 72:310–315 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 Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group (2022) ESHRE guideline: endometriosis. Hum Reprod Open. https://doi.org/10.1093/hropen/hoac009 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 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 Bianchi PHM, Pereira RMA, Zanatta A, Alegretti JR, Motta ELA, Serafini PC (2009) Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 16:174–180 Casals G, Carrera M, Domínguez JA, Abrão MS, Carmona F (2021) Impact of surgery for deep Infiltrative endometriosis before in vitro fertilization: a systematic review and meta-analysis. J Minim Invasive Gynecol 28(7):1303–1312.e5. https://doi.org/10.1016/j.jmig.2021.02.007 Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt W. Küpker, J. Aizpurua, R.E. Felberbaum und K. Diedrich 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 Tanja Fehm, Düsseldorf Wolfgang Küpker, Baden-Baden Stefanie Burghaus, Erlangen 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., Felberbaum, R.E. et al. Endometriose und Infertilität. Gynäkologie 57, 131–137 (2024). https://doi.org/10.1007/s00129-024-05203-3 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00129-024-05203-3