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Uterus myomatosus und Infertilität

Wann und wie intervenieren?

Uterine fibroids and infertility

When and how should interventions be carried out?

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Myome treten aufgrund der veränderten demografischen Bedingungen häufiger bei Kinderwunschpatientinnen auf. Dennoch sollte die Indikation zu allen Therapiemaßnahmen besonders kritisch gestellt werden, da der Zusammenhang zwischen Myomen und Infertilität noch relativ unscharf definiert ist. Insbesondere operative Therapien bei intramuralen Myomen bedürfen einer zurückhaltenden Indikationsstellung, da nicht nur das Myom entfernt wird, sondern auch entsprechende Narben am Uterus entstehen, die bei einer nachfolgenden Schwangerschaft nicht immer unproblematisch sind. Zur medikamentösen Therapie ist Ulipristalacetat die bevorzugte Methode bei Kinderwunschpatientinnen, insbesondere im Rahmen einer präoperativen Vorbehandlung. Der magnetresonanzgesteuerte fokussierte Ultraschall stellt nur für eine ausgewählte Patientengruppe eine mögliche Alternative dar. Fällt die Entscheidung zu einem operativen Vorgehen, sollte dieses unter dem Aspekt einer nachfolgenden Schwangerschaft stets besonders organschonend erfolgen.

Abstract

Leiomyomas occur more often in infertile patients due to the altered demographical conditions. The indications for therapeutic measures should be carefully weighed up, because the association between leiomyomas and infertility is not clear in many clinical situations. The indications for surgical treatment of intramural leiomyomas should be very cautiously evaluated, because not only is the leiomyoma removed but also scarring of the uterus wall could be a problem in a subsequent pregnancy. Ulipristal acetate could be useful in the preoperative treatment before surgical procedures in infertile patients. Magnetic resonance (MR) guided ultrasound treatment is only an alternative in a small group of selected patients. If it is decided that surgery of leiomyomas is the best approach in infertile patients, it should be performed by paying particular attention to subsequent pregnancies by avoiding damage to the surrounding tissue.

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Literatur

  1. Ahrendt HJ, Römer T, Rabe T et al (2014) Management bei symptomatischen Uterusmyomen. Mit den neuen Optionen haben sich die Therapieregime in der frauenärztlichen Praxis geändert. Privatarzt Gynäkol 5:22–25

    Google Scholar 

  2. Ahrendt HJ, Tylskoski H, Rabe T et al (2016) Prevalence of uterine myomas in women in Germany: data of an epidemiological study. Arch Gynecol Obstet 293:1243–1253

    Article  PubMed  Google Scholar 

  3. Arthur R, Kachura J, Liu G, Chan C, Shapiro H (2014) Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve. J Obstet Gynaecol Can 36:240–247

    Article  PubMed  Google Scholar 

  4. Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BW, D’Hooghe TM (2015) Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd009461.pub3

    Google Scholar 

  5. Brito LGO, Panobianco MS, Sabino-de-Freitas MM et al (2014) Uterine leiomyoma: understanding the impact of symptoms on women’s lives. Reprod Health 11:10

    Article  PubMed  PubMed Central  Google Scholar 

  6. Christopoulos G, Vlismas A, Salim R, Islam R, Trew G, Lavery S (2017) Fibroids that do not distort the uterine cavity and IVF success rates: an observational study using extensive matching criteria. BJOG 124:615–621

    Article  CAS  PubMed  Google Scholar 

  7. David M, Kröncke T (2013) Myomembolisation – mögliche Auswirkung auf Fertilität und Schwangerschaftsausgang. Geburtshilfe Frauenheilkd 73:247–255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. DGGG-S3-Leitlinie (2015) Indikationen und Methodik der Hysterektomie bei benignen Erkrankungen – AWMF 015/070, Version 1.2

    Google Scholar 

  9. Donnez J, Tomaszewski J, Vazquez F et al (2012) Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 366:421–432

    Article  CAS  PubMed  Google Scholar 

  10. Donnez J, Donnez O, Matule D et al (2016) Long-term medical management of uterine fibroids with ulipristal acetate. Fertil Steril 105:165–173

    Article  CAS  PubMed  Google Scholar 

  11. Donnez J, Donnez O, Dolmans MM (2016) Safety of treatment of uterine fibroids with the selective progesterone receptor modulator, ulipristal acetate. Expert Opin Drug Saf 15:1679–1686

    Article  CAS  PubMed  Google Scholar 

  12. Donnez J, Dolmans MM (2016) Uterine fibroid management: from the present tot he future. Hum Reprod Update 22:665–686

    Article  PubMed  Google Scholar 

  13. Foth D, Röhl FW, Friedrich C et al (2017) Symptoms of uterine myomas: data of an epidemiological study in Germany. Arch Gynecol Obstet 295:415–426

    Article  PubMed  Google Scholar 

  14. Kim CW, Shim HS, Jang H, Song YG (2016) The effects of uterine artery embolization on ovarian reserve. Eur J Obstet Gynecol Reprod Biol 206:172–176

    Article  PubMed  Google Scholar 

  15. König K, Römer T, Thauer HM, Tinneberg HR (2013) Medikamentöse Behandlung des Uterus myomatosus mit Ulipristalacetat. Frauenarzt 54:974–976

    Google Scholar 

  16. Kröncke T, David M (2015) Uterine artery embolization (UAE) for fibroid treatment-results of the 5th radiological gynecological expert meeting. Rofo 187:483–485

    Article  PubMed  Google Scholar 

  17. Kröncke T, David M (2015) Magnetic resonance guided focused ultrasound for fibroid treatment-results of the second radiological gynecological expert meeting. Rofo 187:480–482

    Article  PubMed  Google Scholar 

  18. Lo Monte G, Piva I, Graziano A, Engl B, Marci R (2016) Ulipristal acetate prior to in vitro fertilization in a female patient affected by uterine fibroids: a case report. Eur Rev Med Pharmacol Sci 20:202–207

    CAS  PubMed  Google Scholar 

  19. Luyckx M, Squifflet JL, Jadoul P et al (2014) First series of 18 pregnancies after ulipristal acetate treatment for uterine fibroids. Fertil Steril 102:1404–1409

    Article  CAS  PubMed  Google Scholar 

  20. Moon JW, Kim CH, Kim JB, Kim SH, Chae HD, Kang BM (2015) Alterations in uterine hemodynamics caused by uterine fibroids and their impact on in vitro fertilization outcomes. Clin Exp Reprod Med 42:163–168

    Article  PubMed  PubMed Central  Google Scholar 

  21. Munro MG, Critchley HO, Broder MS et al (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3–13

    Article  PubMed  Google Scholar 

  22. Osada H, Silbe S, Kahinuma T et al (2011) Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online 22:94–99

    Article  PubMed  Google Scholar 

  23. Römer T (1998) Benefit or GnRH analogue pretreatment for hysteroscopic surgery in patients with bleeding disorders. Gynecol Obstet Invest 45:12–20

    Article  PubMed  Google Scholar 

  24. Römer T (2009) Operative Hysteroskopie, 2. Aufl. De Gruyter, Berlin

    Book  Google Scholar 

  25. Römer T (2015) Operationsindikationen beim Myomen und Kinderwunsch. Privatarzt 2:14–15

    Google Scholar 

  26. Römer T, Doubek K, Foth D et al (2017) Symptomatischer Uterus myomatosus – Zielgerichtete medikamentöse Therapie. Frauenarzt 58:497–503

    Google Scholar 

  27. Shokeir TA (2005) Hysteroscopic management of submucous fibroids to improve fertility. Arch Gynecol Obstet 273:50–54

    Article  PubMed  Google Scholar 

  28. Tian YC, Wu JH, Wang HM, Dai YM (2017) Improved fertility following enucleation of intramural myomas in infertile women. Chin Med J (Engl) 130:1648–1653

    Article  Google Scholar 

  29. Williams VS, Jones G, Mauskopf J et al (2006) Uterine fibroids: a review of health-related quality of life assessment. J Womens Health (Larchmt) 15:818–829

    Article  Google Scholar 

  30. Zepiridis LI, Grimbizis GF, Tarlatzis BC (2016) Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol 34:66–73

    Article  PubMed  Google Scholar 

  31. Römer T, Ahrendt H‑J, Rabe T (2013) Medikamentöse Therapie von Myomen. Frauenarzt 54:374–380

    Google Scholar 

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Authors and Affiliations

  1. Abteilung für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus Köln-Weyertal gGmbH, Weyertal 76, 50931, Köln, Deutschland

    T. Römer

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T. Römer hat Honorare für Vorträge und für Tätigkeiten in wissenschaftlichen Beiräten von Bayer, Gedeon Richter, MSD, ARISTO und HEXAL erhalten.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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G. Griesinger, Lübeck

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Römer, T. Uterus myomatosus und Infertilität. Gynäkologische Endokrinologie 15, 266–272 (2017). https://doi.org/10.1007/s10304-017-0153-z

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