Endometriose und Kinderwunsch – wann ist eine Operation angezeigt?

Zusammenfassung Endometriose ist eine häufige gutartige Erkrankung, die bei jungen Frauen zu Schmerzen, Organdysfunktion und Infertilität führen kann. Medikamentöse, chirurgische und reproduktionsmedizinische Therapien stehen zur Verfügung und können jeweils allein oder in Kombination eingesetzt werden. Entscheidend für die individuelle Therapieplanung ist eine sorgfältige prätherapeutische Diagnostik mittels Anamnese, klinisch-gynäkologischer Untersuchung, transvaginaler Sonographie und/oder Magnetresonanztomographie. Eine Operation kann auch bei Patientinnen mit Endometriose und unerfülltem Kinderwunsch der richtige therapeutische Schritt sein, allerdings ist der optimale Zeitpunkt je nach Stand der Familienplanung, des Lebensalters und der bisherigen Vorgeschichte individuell zu wählen. Idealerweise wird diese Entscheidung in einem multidisziplinären Endometriose-Board getroffen, an dem alle beteiligten Fachdisziplinen teilnehmen sollten. Wenn eine Operation durchgeführt wird, sollte die Endometriose vollständig exzidiert werden, ohne dabei Komplikationen zu verursachen und unter maximaler Schonung aller für die Fertilität relevanten Strukturen. Abstract Endometriosis is a frequent benign disease that can cause pelvic pain, dysmenorrhoe, dyschezia, dysuria, organ dysfuntion and infertility. Medical, surgical and reproductive treatment approaches exist. A meticulous pretherapeutic diagnosis of the extent of the disease, combining patient history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging, is the condition for a tailored individualized approach. Surgery can be an important factor in the treatment of infertile patients with endometriosis. The optimal moment for a surgery can differ individually depending on age, family planning and clinical history. Ideally, a multidisciplinary endometriosis board, including surgeons, sonographers, radiologists and specialists in reproductive medicine, decides on the best solution. The aim of endometriosis surgery should be the complete fertility-sparing excision of all lesions without complications. Similar content being viewed by others Literatur Bonavina G, Taylor HS (2022) Endometriosis-associated infertility: from pathophysiology to tailored treatment. Front Endocrinol 13:1020827. https://doi.org/10.3389/fendo.2022.1020827 Huang Q, Yu Y, Xu W, Li S, Zhou Y, Shu J (2023) The role of peritoneal immunity in peritoneal endometriosis and related infertility. Front Biosci 28(8):166. https://doi.org/10.31083/j.fbl2808166 Somigliana E, Garcia-Velasco JA (2015) Treatment of infertility associated with deep endometriosis: definition of therapeutic balances. Fertil Steril 104(4):764–770. https://doi.org/10.1016/j.fertnstert.2015.08.003 Pados G, Gordts S, Sorrentino F, Nisolle M, Nappi L, Daniilidis A (2023) Adenomyosis and infertility: a literature review. Medicina 59(9):1551. https://doi.org/10.3390/medicina59091551 Schliep KC, Pollack AZ, Farland LV, Shaaban M, Yan B, Wang J, Ghabayen L, Hemmert RB, Stanford JB, Peterson CM (2024) Is endometriosis typology a potentially better classification system for assessing risk of female infertility? F S Rep 5(4):394–401. https://doi.org/10.1016/j.xfre.2024.08.009 Colombi I, Ginetti A, Cannoni A, Cimino G, d’Abate C, Schettini G, Giorgi M, Raimondo D, Martire FG, Lazzeri L, Zupi E, Centini G (2024) Combine surgery and in vitro fertilization (IVF) in endometriosis-related infertility: when and why. J Clin Med 13(23):7349. https://doi.org/10.3390/jcm13237349 Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G (2024) Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an international consensus statement. Ultrasound Obstet Gynecol 64(1):129–144. https://doi.org/10.1002/uog.27560 Di Giovanni A, Montanari E, Hudelist G, Malzoni M, Keckstein J (2023) Comparison between sonography-based and surgical evaluation of endometriotic lesions using the #Enzian classification—a retrospective data analysis. Ultraschall Med 44(3):290–298. https://doi.org/10.1055/a-1713-3573 Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G (2021) The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 100(7):1165–1175. https://doi.org/10.1111/aogs.14099 Burla L, Kalaitzopoulos DR, Samartzis N, Khazali S, Bokor A, Renner SP, Hudelist G, Constantin AS, Schäfer SD, Nassif J, Naem A, Keckstein J, Krentel H, EEL MDT meeting Consensus Group (2024) Recommendations for the implementation and conduct of multidisciplinary team meetings for those providing endometriosis and adenomyosis care—a Delphi consensus of the European endometriosis league (EEL). Facts Views Vis Obgyn 16(3):337–350. https://doi.org/10.52054/FVVO.16.3.038 Keckstein J, Hoopmann M, Merz E, Grab D, Weichert J, Helmy-Bader S, Wölfler M, Bajka M, Mechsner S, Schäfer S, Krentel H, Hudelist G (2023) Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 307(1):5–19. https://doi.org/10.1007/s00404-022-06766-z Rangi S, Hur C, Richards E, Falcone T (2023) Fertility preservation in women with endometriosis. J Clin Med 12(13):4331. https://doi.org/10.3390/jcm12134331 Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, Van Hanegem N, Vulliemoz N, Vermeulen N, ESHRE Endometriosis Guideline Group (2022) ESHRE guideline: endometriosis. Hum Reprod Open 2022(2):hoac9. https://doi.org/10.1093/hropen/hoac009 Knez J, Bean E, Nijjar S, Tellum T, Chaggar P, Jurkovic D (2023) Natural progression of deep pelvic endometriosis in women who opt for expectant management. Acta Obstet Gynecol Scand 102(10):1298–1305. https://doi.org/10.1111/aogs.14491 Kishi Y, Yabuta M, Taniguchi F (2014) Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril 102(3):802–807.e1. https://doi.org/10.1016/j.fertnstert.2014.05.028 Ferrari FA, Youssef Y, Naem A, Ferrari F, Odicino F, Krentel H, Moawad G (2024) Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward? Front Med 11:1387036. https://doi.org/10.3389/fmed.2024.1387036 Chapron C, Marcellin L, Borghese B, Santulli P (2019) Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 15(11):666–682. https://doi.org/10.1038/s41574-019-0245-z Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S (2021) When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet 304(1):143–155. https://doi.org/10.1007/s00404-021-05971-6 Blanc M, von Theobald P (2017) Fertility after surgery for deep infiltrating endometriosis. J Gynecol Obstet Hum Reprod 46(2):143–146. https://doi.org/10.1016/j.jogoh.2016.12.005 Dabi Y, Ebanga L, Favier A, Kolanska K, Puchar A, Jayot A, Ferrier C, Touboul C, Bendifallah S, Darai E (2024) Discoid excision for colorectal endometriosis associated infertility: a balance between fertility outcomes and complication rates. J Gynecol Obstet Hum Reprod 53(2):102723. https://doi.org/10.1016/j.jogoh.2024.102723 Roman H, Dennis T, Forestier D, François MO, Assenat V, Chanavaz-Lacheray I, Denost Q, Merlot B (2023) Excision of deep rectovaginal endometriosis nodules with large infiltration of both rectum and vagina: what is a reasonable rate of preventive stoma? A comparative study. J Minim Invasive Gynecol 30(2):147–155. https://doi.org/10.1016/j.jmig.2022.11.006 Volodarsky-Perel A, Roman H, Francois MO, Jehaes C, Dennis T, Kade S, Forestier D, Assenat V, Merlot B, Denost Q (2024) Low rectal resection for low rectal endometriosis and rectal adenocarcinoma: are we discussing the same risks? Int J Gynaecol Obstet 167(2):823–830. https://doi.org/10.1002/ijgo.15691 Dhanawat J, Pape J, Freytag D, Maass N, Alkatout I (2020) Ovariopexy-before and after endometriosis surgery. Biomedicines 8(12):533. https://doi.org/10.3390/biomedicines8120533 Younis JS, Taylor HS (2024) The impact of ovarian endometrioma and endometriotic cystectomy on anti-Müllerian hormone, and antral follicle count: a contemporary critical appraisal of systematic reviews. Front Endocrinol 15:1397279. https://doi.org/10.3389/fendo.2024.1397279 Bourdon M, Dahan Y, Maignien C, Patrat C, Bordonne C, Marcellin L, Chapron C, Santulli P (2022) Influence of endometrioma size on ART outcomes. Reprod Biomed Online 45(6):1237–1246. https://doi.org/10.1016/j.rbmo.2022.08.097 Exacoustos C, De Felice G, Pizzo A, Morosetti G, Lazzeri L, Centini G, Piccione E, Zupi E (2018) Isolated ovarian endometrioma: a history between myth and reality. J Minim Invasive Gynecol 25(5):884–891. https://doi.org/10.1016/j.jmig.2017.12.026 Daniilidis A, Grigoriadis G, Kalaitzopoulos DR, Angioni S, Kalkan Ü, Crestani A, Merlot B, Roman H (2023) Surgical management of ovarian endometrioma: impact on ovarian reserve parameters and reproductive outcomes. J Clin Med 12(16):5324. https://doi.org/10.3390/jcm12165324 Kalaitzopoulos DR, Zografou M, Nirgianakis K, Daniilidis A, Krentel H, Eberhard M, Samartzis N (2023) Treatment after endometrioma recurrence: a narrative review. Minerva Obstet Gynecol 75(5):449–459. https://doi.org/10.23736/S2724-606X.23.05249-1 Frankowska K, Dymanowska-Dyjak I, Abramiuk M, Polak G (2024) The efficacy and safety of transvaginal ethanol sclerotherapy in the treatment of endometrial cysts—a systematic review. Int J Mol Sci 25(2):1337. https://doi.org/10.3390/ijms25021337 Mifsud JM, Pellegrini L, Cozzolino M (2023) Oocyte cryopreservation in women with ovarian endometriosis. J Clin Med 12(21):6767. https://doi.org/10.3390/jcm12216767 Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E (2014) Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 28(6):704–713. https://doi.org/10.1016/j.rbmo.2014.02.006 Dueholm M (2017) Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand 96(6):715–726. https://doi.org/10.1111/aogs.13158 Harmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, Hehenkamp WJK, Groenman F, De Bruyn C, Rasmussen C, Lazzeri L, Jokubkiene L, Jurkovic D, Naftalin J, Tellum T, Bourne T, Timmerman D, Huirne JAF (2022) Consensus on revised definitions of morphological uterus sonographic assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol 60(1):118–131. https://doi.org/10.1002/uog.24786 Zhang M, Bazot M, Tsatoumas M, Munro MG, Reinhold C (2023) MRI of adenomyosis: where are we today? Can Assoc Radiol J 74(1):58–68. https://doi.org/10.1177/08465371221114197 Moawad G, Youssef Y, Fruscalzo A, Khedhri S, Faysal H, Pirtea P, Guani B, Vallée A, Ayoubi JM, Feki A (2024) Effects of pretreatment strategies on fertility outcomes in patients with adenomyosis. Front Reprod Health 6:1484202. https://doi.org/10.3389/frph.2024.1484202 Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O (2011) Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online 22(1):94–99. https://doi.org/10.1016/j.rbmo.2010.09.014 Athanasiou A, Fruscalzo A, Dedes I, Mueller MD, Londero AP, Marti C, Guani B, Feki A (2024) Advances in adenomyosis treatment: high-intensity focused ultrasound, percutaneous microwave therapy, and radiofrequency ablation. J Clin Med 13(19):5828. https://doi.org/10.3390/jcm13195828 Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt H. Krentel, D. Andrikos, P. Tanovska, I. Vlachodimitris und R.L. De Wilde geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Redaktion Ariane Germeyer, Heidelberg Georg Griesinger, Lübeck Wolfgang Küpker, Baden-Baden Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Krentel, H., Andrikos, D., Tanovska, P. et al. Endometriose und Kinderwunsch – wann ist eine Operation angezeigt?. Gynäkologische Endokrinologie 23, 74–79 (2025). https://doi.org/10.1007/s10304-025-00619-z Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10304-025-00619-z Schlüsselwörter - Weibliche Infertilität - Peritoneale Endometriose - Tief infiltrierende Endometriose - Ovarielle Endometriose - Adenomyose