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Endometriose und Infertilität

Endometriosis and infertility

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Zusammenfassung

Die Fertilität ist bei Endometriosepatientinnen häufig eingeschränkt. Ursächlich dafür sind Störungen der ovariellen Funktion, der Tuben sowie der endometrialen Rezeptivität. Die Mechanismen, auf denen diese Störungen beruhen, sind vielfältig: Störungen der Follikulogenese, oxidativer Stress, Veränderungen des hormonellen Milieus im Ovar und in der Peritonealflüssigkeit, molekularbiologisch nachgewiesene Veränderungen im eutopen Endometrium. Die klassische medikamentöse Behandlung der Endometriose besteht in der Unterdrückung der zyklischen ovariellen Aktivität und steht somit einer direkten, aktiven Kinderwunschtherapie entgegen. Eine alleinige medikamentöse ovarielle Suppression führt nicht zu einer Verbesserung der Fertilität. Operative Maßnahmen mit Entfernung von Endometrioseherden und Adhäsiolyse zeigen dagegen eine Verbesserung der Schwangerschaftsraten. Im Vergleich zu einer abwartenden Strategie bieten Maßnahmen der künstlichen Befruchtung in allen Stadien der Endometriose einen Vorteil, die Erfolgsaussichten sind aber im Vergleich zu denen bei alleiniger tubarer oder idiopathischer Sterilität niedriger einzustufen.

Abstract

Reduced fertility is a typical finding in patients with endometriosis. Changes in ovarian function, tubal factors, and, probably, reduced endometrial receptivity are causes for subfertility in these patients. The mechanisms responsible for these changes are multiple: defects in folliculogenesis, oxidative stress, hormonal and inflammatory changes in the ovary and peritoneal fluid, and molecular changes in eutopic endometrium. The classic pharmaceutical therapies suppress ovulation and thereby work against fertility and pregnancy during therapy. This classic therapy also does not improve the chances of fertility in the future. Surgical approaches with destruction of the endometriosis and removal of adhesions improve fertility rates. Compared with a wait-and-see strategy, all assisted reproductive techniques improve the chances for pregnancy in patients with endometriosis; however, these seem to be lower than for those with tubal or idiopathic infertility.

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Correspondence to Dr. R. Popovici.

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Popovici, R. Endometriose und Infertilität. Gynäkologe 42, 43–49 (2009). https://doi.org/10.1007/s00129-008-2319-1

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Schlüsselwörter

  • Endometriose
  • Fertilität
  • Laparoskopie
  • Medikamentöse Therapie
  • ART

Keywords

  • Endometriosis
  • Fertility
  • Laparoscopy
  • Pharmaceutical therapy
  • Assisted reproductive technology