Schwangerschaft trotz Endometriose

In: Der Gynäkologe · 2015 · vol. 48(3) , pp. 216–220 · doi:10.1007/s00129-014-3420-2 · W1681067
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This review discusses various endometriosis therapies and their association with pregnancy rates, given the unclear link between the condition and infertility.

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This paper is a literature review discussing pregnancy chances in women with endometriosis by comparing different therapy options, including individualized hormonal stimulation protocols with and without subsequent assisted reproduction, and the potential role of surgery in improving pregnancy rates. It focuses on the idea that infertility mechanisms in endometriosis are incompletely clarified, with assumptions that both oocyte quality and ovarian reserve may be altered, which motivates the need for individualized approaches rather than standardized algorithms. A major limitation stated is that there are no fully defined, standardized treatment pathways yet and the usefulness of surgical interventions and specific stimulation strategies must be evaluated in the context of the pregnancy-rate evidence. This paper is centrally about endometriosis — it reviews therapies (including assisted reproduction and possible operative interventions) aimed at improving pregnancy chances in the setting of endometriosis-associated infertility.

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Abstract

Background The reasons for infertility in patients with endometriosis are still not satisfactorily clarified even if in recent years it has been assumed that oocyte quality as well as the ovarian reserve are altered. This implies that the treatment cannot be standardized for every patient but must be individualized; however, the usefulness of surgery and the different stimulation protocols followed by assisted reproduction need to be evaluated.

Objective

The aim of this study was to review the literature about the different therapies in the context of the pregnancy rates. Similar content being viewed by others Literatur 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(4):535–549 Bulun SE (2009) Endometriosis. N Engl J Med 360(3):268–279 Gupta S, Goldberg JM, Aziz N et al (2008) Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril 90(2):247–257 Simón C, Gutiérrez A, Vidal A et al (1994) Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod 9(4):725–729 Navroth F, Ludwig M, Gnoth C et al (2014) Bewertung von ovarieller Reserve und Fertilität mit steigendem. Lebensalter 11(1):6–11 Wang MH, Chen CH, Wang CW et al (2014) A higher anti-Müllerian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination. J Obstet Gynaecol 1–5 Pacchiarotti A, Frati P, Milazzo GN et al (2014) Evaluation of serum anti-Mullerian hormone levels to assess the ovarian reserve in women with severe endometriosis. Eur J Obstet Gynecol Reprod Biol 172:62–64 Kim JY, Jee BC, Suh CS, Kim SH (2013) Preoperative serum anti-mullerian hormone level in women with ovarian endometrioma and mature cystic teratoma. Yonsei Med J 54(4):921–926 Shebl O, Ebner T, Sommergruber M et al (2009) Anti muellerian hormone serum levels in women with endometriosis: a case-control study. Gynecol Endocrinol 25(11):713–716 Sugita A, Iwase A, Goto M et al (2013) One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril 100(2):516–522.e3 Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium (2013) Consensus on current management of endometriosis. Hum Reprod 28(6):1552–1568 Van der Houwen LEE, Schreurs AMF, Schats R et al (2014) Efficacy and safety of intrauterine insemination in patients with moderate-to-severe endometriosis. Reprod Biomed Online 28(5):590–598 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 Rickes D, Nickel I, Kropf S, Kleinstein J (2002) Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril 78(4):757–762 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 1:CD004635 Tamura H, Takasaki A, Nakamura Y et al (2014) A pilot study to search possible mechanisms of ultralong gonadotropin-releasing hormone agonist therapy in IVF-ET patients with endometriosis. J Ovarian Res 7(1):100 Practice Committee of the American Society for Reproductive Medicine (2012) Endometriosis and infertility: a committee opinion. Fertil Steril 98(3):591–598 Crosignani PG, Vercellini P, Biffignandi F et al (1996) Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril 66(5):706–711 Bianchi PHM, Pereira RMA, Zanatta A et al (2009) Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 16(2):174–180 Barri PN, Coroleu B, Tur R et al (2010) Endometriosis-associated infertility: surgery and IVF, a comprehensive therapeutic approach. Reprod Biomed Online 21(2):179–185 Raffi F, Metwally M, Amer S (2012) The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 97(9):3146–3154 Streuli I, Ziegler D de, Gayet V et al (2012) In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod 27(11):3294–3303 Somigliana E, Berlanda N, Benaglia L (2012) Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 98(6):1531–1538 Donnez J, Wyns C, Nisolle M (2001) Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril 76(4):662–665 Einhaltung ethischer Richtlinien Interessenkonflikt. M. Rodewald, T. Gundelach, E. Bauer, P. Widschwendter, W. Janni und K. Hancke geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Rodewald, M., Gundelach, T., Bauer, E. et al. Schwangerschaft trotz Endometriose. Gynäkologe 48, 216–220 (2015). https://doi.org/10.1007/s00129-014-3420-2 Published: Issue date: DOI: https://doi.org/10.1007/s00129-014-3420-2 Schlüsselwörter - Tief infiltrierende Endometriose - Assistierte Reproduktion - Fertilität - Schwangerschaftschancen - Anti-Müller-Hormon

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