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Infertilität bei Frauen

Neueste Entwicklungen

Infertility in women

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Hintergrund

Die Häufigkeit der Infertilität bei Frauen ist seit 1990 weitgehend unverändert. Zu ihrer Behandlung werden neben den Methoden der In-vitro-Fertilisation (IVF) und der intrazytoplasmatischen Spermieninjektion (ICSI) heute auch neue Wege beschritten, die auf neuen Erkenntnissen zu den Ursachen der Infertilität basieren.

Ziel

Ziel des vorliegenden Beitrages ist die Darstellung des aktuellen Kenntnisstandes zu den Ursachen der Infertilität bei Frauen und zu ihren Behandlungsmöglichkeiten.

Methoden

Es wurde eine Literaturrecherche durchgeführt, um die ursächlichen demografischen Faktoren, Infektionen, anatomischen Veränderungen, endokrinologischen und metabolischen Störungen, den Einfluss einer Endometriose, Faktoren des Lebensstils, Umweltfaktoren und psychische Faktoren sowie die Therapieempfehlungen zu erfassen.

Ergebnisse

Chlamydien sind nach wie vor die Hauptursache der infektiologisch bedingten Sterilität. Die Korrektur endokriner und metabolischer Störungen zur Wiederherstellung der eigenen Fruchtbarkeit, insbesondere des Schilddrüsen- und Zuckerstoffwechsels sowie die Fertilitätschirurgie stehen wieder vermehrt im Fokus. Die Diagnostik und Therapie von Implantationsstörungen sind jedoch noch nicht weit entwickelt.

Schlussfolgerung

Neben der assistierten Befruchtung sind heute Konzepte zur Optimierung der eigenen Fertilität wieder in den Mittelpunkt des Interesses gerückt.

Abstract

Background

The incidence of female infertility has not changed since the early 1990s. Based on new data from basic research on infertility, novel options in the diagnostics and treatment of infertility have emerged, besides in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Aim

This review summarizes the current knowledge on female infertility and on modern concepts in diagnostics and treatment.

Methods

A literature research on the causes of infertility and on treatment options was performed, including demographic factors, infectiology, anatomy, endocrinology and metabolism, endometriosis, lifestyle and environmental factors, and psychological factors.

Results

Chlamydial infection is still the major cause of tubal infertility. Improvement of the patient’s fertility by correction of endocrine and metabolic disorders, in particular thyroid dysfunction and glucose metabolism, as well as fertility surgery are of main interest.

Conclusions

Besides assisted reproductive techniques, concepts to optimize individual fertility have gained increasing importance.

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Literatur

  1. WHO (2002) Current practices and controversies in assisted reproduction. Report of a meeting on „Medical, Ethical and Social Aspects of Assisted Reproduction“. In: Vayena E, Rowe PJ, Griffin PD (Hrsg). http://whqlibdoc.who.int/hq/2002/9241590300.pdf (Zugegriffen: 16.08.2012)

  2. Practice committee of the American Society for Reproductive Medicine (2008) Definitions of infertility and recurrent pregnancy loss. Fertil Steril 90:S60

    Google Scholar 

  3. Van Noord-Zaadstra BM, Looman CW, Alsbach H et al (1991) Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ 302:1361–1365

    Article  Google Scholar 

  4. Dunson DB, Colombo B, Baird DD (2002) Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod 17:1399–1403

    Article  PubMed  Google Scholar 

  5. Gnoth C, Godehardt D, Godehardt E et al (2003) Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 18:1959–1966

    Article  PubMed  CAS  Google Scholar 

  6. Boivin J, Bunting L, Collins JA, Nygren KG (2007) International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 22:1506–1512

    Article  PubMed  Google Scholar 

  7. Van der Ven H, Kühr M, Roth S, Ven K van der (2013) Nimmt die gynäkologische Fertilität ab? Gynäkologe 46:12–17

    Article  Google Scholar 

  8. McLaren JF (2012) Infertility evaluation. Obstet Gynecol Clin North Am 39:453–463

    Article  PubMed  Google Scholar 

  9. Herbert DL, Lucke JC, Dobson AJ (2012) Birth outcomes after spontaneous or assisted conception among infertile Australian women aged 28–36 years: a prospective, population-based study. Fertil Steril 97:630–638

    Article  PubMed  Google Scholar 

  10. Custers IM, Rumste MM van, Steeg JW van der et al (2012) Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment. Hum Reprod 27:444–450

    Article  PubMed  Google Scholar 

  11. Karmon A, Hailpern SM, Neal-Perry G et al (2011) Association of ethnicity with involuntary childlessness and perceived reasons for infertility: baseline data from the Study of Women’s Health Across the Nation (SWAN). Fertil Steril 96:1200–1205

    Article  PubMed  PubMed Central  Google Scholar 

  12. Diedrich K (2008) Zusammenfassung – Reproduktionsmedizin im internationalen Vergleich. In: Diedrich K et al (Hrsg) Reproduktionsmedizin im internationalen Vergleich. Friedrich-Ebert-Stiftung, Berlin, S 112–114

  13. Stephen EH, Chandra A (2006) Declining estimates of infertility in the United States. Fertil Steril 86:516–523

    Article  PubMed  Google Scholar 

  14. Ray A, Shah A, Gudi A, Homburg R (2012) Unexplained infertility: an update and review of practice. Reprod Biomed Online 24:591–602

    Article  PubMed  Google Scholar 

  15. Van Geloven N, Van der Veen F, Bossuyt PM et al (2013) Can we distinguish between infertility and subfertility when predicting natural conception in couples with an unfulfilled child wish? Hum Reprod 28:658–665

    Article  Google Scholar 

  16. Kuohung W, Hornstein MD (2013) Overview of infertility. Up to date. Topic 7396, Version 13.0. Wolters Kluwer Health, Philadelphia

  17. Mutsaerts MA, Groen H, Huiting HG et al (2012) The influence of maternal and paternal factors on time to pregnancy – a Dutch population-based birth-cohort study: the GECKO Drenthe study. Hum Reprod 27:583–593

    Article  PubMed  CAS  Google Scholar 

  18. Schmidt L, Sobotka T, Bentzen JG et al (2012) Demographic and medical consequences of the postponement of parenthood. Hum Reprod Update 18:29–43

    Article  PubMed  CAS  Google Scholar 

  19. McReynolds S, Dzieciatkowska M, McCallie BR et al (2012) Impact of maternal aging on the molecular signature of human cumulus cells. Fertil Steril 98:1574–1580.e5

    Article  PubMed  CAS  Google Scholar 

  20. Delmonte S, Latino MA (2012) Looking for an asymptomatic infection: usefulness of screening for Chlamydia trachomatis and genital herpes. G Ital Dermatol Venereol 147:431–445

    PubMed  CAS  Google Scholar 

  21. Datta SD, Torrone E, Kruszon-Moran D et al (2012) Chlamydia trachomatis trends in the United States among persons 14–39 years of age, 1999–2008. Sex Transm Dis 39:92–96

    Article  PubMed  Google Scholar 

  22. Price MJ, Ades AE, Welton NJ et al (2012) How much tubal factor infertility is caused by Chlamydia? Estimates based on serological evidence corrected for sensitivity and specificity. Sex Transm Dis 39:608–613

    Article  PubMed  Google Scholar 

  23. Kortekangas-Savolainen O, Mäkinen J, Koivusalo K, Mattila K (2012) Hospital-diagnosed late sequelae after female Chlamydia trachomatis infections in 1990–2006 in Turku, Finland. Gynecol Obstet Invest 73:299–303

    Article  PubMed  Google Scholar 

  24. Coppus SF, Land JA, Opmeer BC et al (2011) Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. Hum Reprod 26:3061–3067

    Article  PubMed  CAS  Google Scholar 

  25. Ndowa F, Lusti-Narasimhan M (2012) The threat of untreatable gonorrhoea: implications and consequences for reproductive and sexual morbidity. Reprod Health Matters 20:76–82

    Article  PubMed  Google Scholar 

  26. Manhart LE, Broad JM, Golden MR (2011) Mycoplasma genitalium: should we treat and how? Clin Infect Dis 53(Suppl 3):S129–S142

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wiesenfeld HC, Hillier SL, Meyn LA et al (2012) Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol 120:37–43

    Article  PubMed  Google Scholar 

  28. Unuane D, Tournaye H, Velkeniers B, Poppe K (2011) Endocrine disorders & female infertility. Best Pract Res Clin Endocrinol Metab 25:861–873

    Article  PubMed  CAS  Google Scholar 

  29. Velkeniers B, Van Meerhaeghe A, Poppe K et al (2013) Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction techniques: systematic review and meta-analysis of RCTs. Hum Reprod Update 19:251–258

    Article  PubMed  CAS  Google Scholar 

  30. Kachuei M, Jafari F, Kachuei A, Keshteli AH (2012) Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet 285:853–856

    Article  PubMed  CAS  Google Scholar 

  31. Artini PG, Uccelli A, Papini F et al (2013) Infertility and pregnancy loss in euthyroid women with thyroid autoimmunity. Gynecol Endocrinol 29:36–41

    Article  PubMed  CAS  Google Scholar 

  32. Hassani Y, Larroque B, Dos Santos S et al (2012) Fecundity in young adults treated early for congenital hypothyroidism is related to the initial severity of the disease: a longitudinal population-based cohort study. J Clin Endocrinol Metab 97:1897–1904

    Article  PubMed  CAS  Google Scholar 

  33. Propst AM, Bates GW Jr (2012) Evaluation and treatment of anovulatory and unexplained infertility. Obstet Gynecol Clin North Am 39:507–519

    Article  PubMed  Google Scholar 

  34. Fauser BC, Tarlatzis BC, Rebar RW et al (2012) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 97:28–38.e25

    Article  PubMed  Google Scholar 

  35. Morin-Papunen L, Rantala AS, Unkila-Kallio L et al (2012) Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): a multicenter, double-blind, placebo-controlled randomized trial. J Clin Endocrinol Metab 97:1492–1500

    Article  PubMed  CAS  Google Scholar 

  36. Koninckx PR, Ussia A, Adamyan L et al (2012) Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 98:564–571

    Article  PubMed  Google Scholar 

  37. Strowitzki T, Marr J, Gerlinger C et al (2010) Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 25:633–641

    Article  PubMed  CAS  Google Scholar 

  38. Moran LJ, Dodd J, Nisenblat V, Norman RJ (2011) Obesity and reproductive dysfunction in women. Endocrinol Metab Clin North Am 40:895–906

    Article  PubMed  CAS  Google Scholar 

  39. Moragianni VA, Jones SM, Ryley DA (2012) The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril 98:102–108

    Article  PubMed  Google Scholar 

  40. Kumbak B, Oral E, Bukulmez O (2012) Female obesity and assisted reproductive technologies. Semin Reprod Med 30:507–516

    Article  PubMed  Google Scholar 

  41. Bonneau C, Chanelles O, Sifer C, Poncelet C (2012) Use of laparoscopy in unexplained infertility. Eur J Obstet Gynecol Reprod Biol 163:57–61

    Article  PubMed  CAS  Google Scholar 

  42. Merhi ZO (2012) Challenging cell phone impact on reproduction: a review. J Assist Reprod Genet 29:293–297

    Article  PubMed  PubMed Central  Google Scholar 

  43. Benedict MD, Missmer SA, Vahratian A et al (2011) Secondhand tobacco smoke exposure is associated with increased risk of failed implantation and reduced IVF success. Hum Reprod 26:2525–2531

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lynch CD, Sundaram R, Buck Louis GM et al (2012) Are increased levels of self-reported psychosocial stress, anxiety, and depression associated with fecundity? Fertil Steril 98:453–458

    Article  PubMed  Google Scholar 

  45. Sacks G, Yang Y, Gowen E et al (2012) Detailed analysis of peripheral blood natural killer cells in women with repeated IVF failure. Am J Reprod Immunol 67:434–442

    Article  PubMed  CAS  Google Scholar 

  46. Di Nisio M, Rutjes AW, Ferrante N et al (2011) Thrombophilia and outcomes of assisted reproduction technologies: a systematic review and meta-analysis. Blood 118:2670–2678

    Article  Google Scholar 

  47. Laufer N, Simon A (2012) Recurrent implantation failure: current update and clinical approach to an ongoing challenge. Fertil Steril 98:166–172

    Article  PubMed  Google Scholar 

  48. Najafi T, Novin MG, Ghazi R, Khorram O (2012) Altered endometrial expression of endothelial nitric oxide synthase in women with unexplained recurrent miscarriage and infertility. Reprod Biomed Online 25:408–414

    Article  PubMed  CAS  PubMed Central  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Strowitzki war principal investigator der europäischen Studien zur Therapie mit Dienogest bei Endometriose und ist Lecturer mit Unterstützung von Bayer Health care. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland

    T. Strowitzki

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Correspondence to T. Strowitzki.

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Strowitzki, T. Infertilität bei Frauen. Bundesgesundheitsbl. 56, 1628–1632 (2013). https://doi.org/10.1007/s00103-013-1851-x

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