Beratung und Therapie der Kinderwunschpatientin beim PCO-Syndrom

Conference paper


  1. 1.

    Das PCO-Syndrom (PCOS) ist eine der häufigsten Endokrinopathien bei der Frau. 5–10% der Frauen in der Prämenopause sind hiervon betroffen. Bei 75% der anovulatorischen Sterilität ist das PCOS die pathogenetische Ursache.

  2. 2.

    Pathogenese: Insulinresistenz mit kompensatorischer Hyperinsulinämie, erhöhte LH-Pulsfrequenz/Amplitude → erhöhte Thekazell-/Stroma-Stimulation → erhöhte ovarielle Testosteron-/Androstendionbiosynthese/-sekretion; veränderter Androgenmetabolismus der Thekazellen; familiäre genetische Disposition zur Adipositas, Insulinresistenz, pathologischen ovariellen/adrenalen Androgenproduktion.

  3. 3.

    Diagnostik: a) Symptome: Zyklusstörungen, Hirsutismus, Akne; b) Ultraschall + Hormonanalyse; c) Insulin-/Glucosemetabolismus (Insulinresistenz?) insbesondere bei Adipositas.

  4. 4.

    Therapie: Gewichtsreduktion und Bewegung bei Adipositas; instabile Zyklen → Oligo/ Amenorrhoe: 1. Clomifen (CC): beginnend niedrig dosiert mit 25–50 mg/die, 2. kombinierte CC-/FSH-hMG-Therapie, 3.low dose FSH-hmg-Therapie; stimulationsresistente Ovarien: bei Insulinresistenz Basistherapie 1500 mg/die Metformin, evtl. ovarielle Punktkoagulation.

  5. 5.

    Wünschenswerte Perspektiven bei der Therapie von Patienten mit PCOS: Frühzeitige gynäkologische Diagnostik des PCOS; frühzeitige internistische Diagnostik der Insulinresistenz mit frühzeitiger Therapie: Verminderung der ovariellen Hyperandrogenämie; Verbesserung der Schwangerschaftsrate; Verminderung der Frühaborte; Verminderung der Adipositas; Verminderung der Entwicklung eines Diabetes mellitus; Verhinderung des metabolischen Syndroms (Hypertonus, Hyperlipidämie, kardiovaskuläre Erkrankung).



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© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • H. Gips

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