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Behandlung der Patientin mit geringem Ansprechen auf die ovarielle Stimulation

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Reproduktionsmedizin

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Zusammenfassung

Ein geringeres Ansprechen der Ovarien auf die FSH-Stimulation ist mit zunehmendem Alter der Normalfall aufgrund der physiologischen Erschöpfung der Eierstöcke. Die entscheidende Voraussetzung für die polyfollikuläre Reifung und somit Gewinnung mehrerer Eizellen für die In-vitro-Fertilisation ist eine noch hinlängliche ovarielle Reserve. Eine geringe Anzahl an Follikeln oder Eizellen trotz intensiver ovarieller Stimulation wird in der Literatur als „poor response“ oder „low response“ bezeichnet. Verschiedene Maßnahmen im Kontext der ovariellen Stimulation wurden in klinischen Studien überprüft, die die Eizellzahl und/oder -qualität und im Gefolge die Schwangerschaftswahrscheinlichkeit für Patientinnen mit verringerter ovarieller Reserve verbessern sollen. In diesem Kapitel wird der Zusammenhang zwischen Stimulationsintensität und ovarieller Antwort erläutert. Ebenso wird der Stellenwert verschiedener Stimulationsprotokolle, die zusätzliche LH-Verabreichung, die Vorbehandlung mit Sexualsteroiden, die Androgenvorbehandlung, die adjuvante Gabe von Wachstumshormon sowie das Konzept der Doppelstimulation erörtert.

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  1. Sektion für gynäkologische Endokrinologie und Reproduktionsmedizin, UNIVERSITÄTSKLINIKUM Schleswig-Holstein – Campus Lübeck, Lübeck, Deutschland

    Georg Griesinger

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  1. Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie Hamburg GmbH, amedes experts, Hamburg, Germany

    Klaus Diedrich

  2. SYNLAB Holding Deutschland GmbH, Augsburg, Hamburg, Germany

    Michael Ludwig

  3. Sektion für gynäkologische Endokrinologie und Reproduktionsmedizin, UNIVERSITÄTSKLINIKUM Schleswig-Holstein – Campus Lübeck, Lübeck, Schleswig-Holstein, Germany

    Georg Griesinger

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Griesinger, G. (2019). Behandlung der Patientin mit geringem Ansprechen auf die ovarielle Stimulation. In: Diedrich, K., Ludwig, M., Griesinger, G. (eds) Reproduktionsmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55601-6_40-1

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