Zusammenfassung
Hintergrund
Adipositas bei infertilen Frauen ist ein zunehmendes Problem mit Auswirkungen auf den Behandlungsverlauf, Schwangerschaftserkrankungen und die spätere gesunde kindliche Entwicklung.
Ziel der Arbeit
Es wird dargestellt, welchen Einfluss das Körpergewicht und insbesondere Übergewicht auf die hormonelle Stimulation bei Maßnahmen der künstlichen Befruchtung haben und wie sich Übergewicht auf die Erfolgsaussichten von Verfahren der assistierten Reproduktion auswirkt.
Ergebnisse
Adipöse Patientinnen zeigen eine deutlich schlechtere hormonelle Stimulierbarkeit, benötigen eine höhere Gonadotropindosis als Normalgewichtige und erzielen eine geringere Eizellzahl. Schwangerschafts- und Lebendgeburtenraten sind signifikant niedriger, die Abortrate ist höher. Eventuelle Vorteile einer intramuskulären Gonadotropingabe im Vergleich zur subkutanen Applikation sind nicht belegt.
Schlussfolgerung
Eine hormonelle Stimulierbarkeit ist bei adipösen Patientinnen zwar gegeben, aber signifikant schlechter als bei Normalgewichtigen. Daher sollte eine prätherapeutische Gewichtsreduktion dringend empfohlen werden, vor allem bei extremer Adipositas.
Abstract
Background
Obesity in infertile women is an endemic problem and has a direct impact on assisted reproductive technology (ART) treatment, in vitro fertilization (IVF) outcome, pregnancy, and development of children in later life.
Objective
The impact of body weight and obesity on controlled ovarian stimulation (COH) for ART and ART outcome is illustrated.
Results
Patients who are obese show a reduced ovarian response to COH, require a higher dose of gonadotropins, and have a reduced oocyte yield compared to normal weight women. Pregnancy and live birth rates are significantly lower, while the miscarriage rate is increased. There is no proven benefit of intramuscular vs. subcutaneous administration route.
Conclusions
Controlled ovarian stimulation is feasible in obese patients, but is significantly worse compared to normal weight patients. Thus, pretherapeutic weight reduction is urgently recommended, particularly in patients with extreme obesity.
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T. Strowitzki und E. Capp geben an, dass kein Interessenkonflikt besteht.
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T. Strowitzki, Heidelberg
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Strowitzki, T., Capp, E. Adipositas und kontrollierte ovarielle Stimulation (COH). Gynäkologische Endokrinologie 15, 126–130 (2017). https://doi.org/10.1007/s10304-017-0121-7
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DOI: https://doi.org/10.1007/s10304-017-0121-7