Treatment of Women with Endometriosis and Subfertility: Results from a Meta-Analysis

Zusammenfassung

Fragestellung: Es werden die Schwangerschaftsraten nach verschiedenen Anwendungen der assistierten reproduktiven Techniken (homologe Insemination, In-vitro-Fertilisation und Eizellspende, ART) zwischen Frauen mit und ohne Endometriose verglichen. Material und Methodik: Metaanalyse und Literaturrecherche von über 40 000 Behandlungszyklen im Zeitraum zwischen 1994 und 2004. Ergebnisse: Die Schwangerschaftsrate nach ovarieller Stimulation und homologer intrauteriner Insemination bei Frauen mit Endometriose war signifikant geringer im Vergleich zu den Kontrollgruppen ohne Endometriose. Hingegen waren die entsprechenden Erfolgsraten nach extrakorporaler Befruchtung und Embryonentransfer statistisch nicht verschieden. Die Ergebnisse der Sterilitätsbehandlung durch Eizellspenden unterstützen die Annahme, dass bei Frauen mit Endometriose die endometriale Rezeptivität nicht gestört ist. Eher wird die These unterstützt, dass die follikuläre Reifung der Eizellen und damit die spätere Qualität der Präimplantationsembryonen bei Endometriose kompromittiert sein können. Schlussfolgerung: Die extrakorporale Befruchtung und der Embryonentransfer nach hormoneller Stimulation repräsentieren die effektivste Behandlung der Subfertilität von Frauen mit Endometriose. Alleinige ovarielle Stimulation in Kombination mit intrauteriner Insemination sind dagegen ungeeignet.

Abstract

Purpose: To compare the pregnancy rates of women with endometriosis to those without endometriosis following controlled ovarian stimulation with intrauterine insemination, IVF/ICSI, or egg donation. The main outcome measures were the clinical pregnancy rates. Material and Methods: Meta-analysis and review of the literature including more than 40 000 treatment cycles. Results: The pregnancy rates following controlled ovarian hyperstimulation (COH) and intrauterine insemination revealed a significantly lower pregnancy rate in women with endometriosis as compared to the control. No significant differences in the pregnancy rates were obtained from IVF/ICSI treatment cycles. The results of egg donation programs provided further evidence that the endometrial receptivity in women with endometriosis is not impaired, but apparently the quality of oocytes with respect to fertilization and implantation is. Conclusion: IVF/ICSI represents an equally effective treatment of infertility in women with endometriosis compared to the control. Hormonal ovarian stimulation in combination with intrauterine insemination by husband in women with endometriosis has been shown to be rather ineffective. These results emphasize the need for attention with respect to the ratifications of national guidelines recommending paths of treatment in women with endometriosis and subfertility.

Schlüsselwörter

Endometriose - Sterilität - Meta‐Analyse

Key words

endometriosis - sterility - meta‐analysis

References

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