Tief infiltrierende Endometriose – Ist eine operative Therapie vor IVF erforderlich?

In: Der Gynäkologe · 2022 · vol. 55(4) , pp. 279–287 · doi:10.1007/s00129-022-04915-8 · W4213379371
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Surgery for deep infiltrating endometriosis can improve fertility, leading to spontaneous pregnancy or pregnancy after assisted reproductive technology, but treatment must be individualized.

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The paper discusses whether deep infiltrating endometriosis (DIE/TIE) surgery is required before IVF to improve fertility, focusing on women with fertility disorders and considering assisted reproductive technology (ART) options. It synthesizes limited available data suggesting that operative treatment for TIE/DIE can improve fertility outcomes, enabling spontaneous conception, pregnancy after prior unsuccessful ART, and additional fertility gains even when ART is performed. A major caveat noted is the restricted evidence base and the need for individualized treatment planning. Relevance to endometriosis: The paper is centrally about endometriosis—specifically deep infiltrating endometriosis (TIE)—and also emphasizes incorporating coexisting adenomyosis into management decisions.

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Zusammenfassung Die tief infiltrierende Endometriose (TIE) ist mit Fertilitätsstörungen assoziiert, die operative Therapie mit teils schwerwiegenden Komplikationen. Zur Verbesserung der Fertilität stehen Maßnahmen der assistierten Reproduktion zur Verfügung. Bei eingeschränkter Datenlage scheint die Operation bei TIE ebenfalls eine Verbesserung der Fertilität zu bewirken. Erreichbar sind insbesondere die Möglichkeit einer spontanen Schwangerschaft, einer Schwangerschaft nach frustraner reproduktionsmedizinischer Behandlung, aber auch die zusätzliche Verbesserung der Fertilität trotz Durchführung von Maßnahmen der assistierten Reproduktion. Bei der Behandlungsplanung muss auch das Vorhandensein einer Adenomyosis berücksichtigt werden. Das Vorgehen bei TIE und Infertilität muss individuell geplant werden. Abstract Deep infiltrating endometriosis (DIE) is associated with disorders of fertility. The operative treatment for DIE is sometimes associated with severe complications. Assisted reproductive technology (ART) can be used to improve fertility. According to the limited data available surgery for DIE also seems to result in improvement of fertility. Operative treatment particularly achieves the possibility of a spontaneous conception, pregnancy after unsuccessful treatment with ART and also the additional improvement of fertility despite carrying out measures for assisted reproduction. The treatment planning must also take the presence of adenomyosis into consideration. The approach in cases of DIE and infertility must be individually planned. Similar content being viewed by others Literatur Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W, European Society of Human Reproduction and Embryology (2014) ESHRE guideline: management of women with endometriosis. 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Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Redaktion Tanja Fehm, Düsseldorf Ludwig Kiesel, Münster Rainer Kimmig, Essen QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Schäfer, S.D. Tief infiltrierende Endometriose – Ist eine operative Therapie vor IVF erforderlich?. Gynäkologe 55, 279–287 (2022). https://doi.org/10.1007/s00129-022-04915-8 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00129-022-04915-8

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