Therapie der Sterilität bei Endometriose - Nutzen und Risiken von reproduktionsmedizinischen Maßnahmen

Zusammenfassung

Sterilität ist ein bei Endometriosepatientinnen häufiger Befund. Während operative Maßnahmen ihren Stellenwert haben, verbessert die alleinige hormonelle Therapie die Erfolgschancen nicht. Im Vergleich zu ausschließlicher Observanz scheinen Maßnahmen der künstlichen Befruchtung in allen Stadien der Endometriose einen Vorteil zu bieten, die Erfolgsaussichten sind aber im Vergleich zu alleiniger tubarer oder idiopathischer Sterilität geringer. Die Erfolgsaussicht der IVF ist dabei durchaus stadienabhängig. Ungeklärt ist nach wie vor die geeignetste Behandlung von Endometriomen und ihre Rolle für das Ergebnis einer IVF. Ultralange Stimulationsprotokolle bieten keine Vorteile gegenüber einem standardisierten Lutealphasenprotokoll. Insbesondere bei Vorliegen zusätzlicher Sterilitätsfaktoren ist die primäre IVF die Methode der Wahl.

Abstract

Infertility is a common clinical finding in patients with endometriosis. Surgical procedures have shown some benefit, whereas endocrine treatment alone does not improve fertility. Although assisted reproduction is superior to observation only, the pregnancy rate after IVF is lower than in patients with tubal or idiopatic infertility. The grade of endometriosis correlates to the pregnancy rate. The role of endometriomas in assisted reproduction is still a matter of debate. Ultralong stimulation protocols have no advantage to standard long luteal phase regimens. In particular in multifactor infertility IVF seems to be the treatment option of choice.

Schlüsselwörter

Endometriose - IVF - Fertilität

Key words

endometriosis - IVF - infertility

Literatur

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