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Erschienen in: Journal für Gynäkologische Endokrinologie/Österreich 4/2022

22.07.2022 | Originalien

Klinische Aspekte des Implantationsversagens

verfasst von: Dr. scient. med. Gregor Weiss, M.Sc., PD Dr. med. univ. Michael Schenk

Erschienen in: Gynäkologie in der Praxis | Ausgabe 4/2022

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Zusammenfassung

Das rezidivierende Implantationsversagen (RIF) ist eine der größten Herausforderungen in der modernen Reproduktionsmedizin. Es bezeichnet den Zustand nach drei fehlgeschlagenen In-vitro-Fertilisations-Versuchen (IVF) mit Embryonen von guter Qualität. In der aktuellen Literatur gibt es keine klare Definition von RIF und standardisierte Tests und Protokolle zur Behandlung fehlen. Reproduktionsmediziner sehen sich mit einer großen Heterogenität an Risikofaktoren, welche zur Ätiologie der Erkrankung beitragen, konfrontiert. Dazu zählen beispielsweise das Alter der Mutter, Body-Mass-Index (BMI), Rauchen und Stress. Aber auch anatomische Anomalien, die Dicke des Endometriums, männliche oder embryonale Einflussfaktoren können für RIF verantwortlich sein. Darüber hinaus erschweren pathophysiologische Mechanismen auf immunologischer Ebene (natürliche Killerzellen, Autoantikörper, Infektionen etc.) einen allgemeinen Behandlungskonsens. Nachdem der Erfolg der reproduktionsmedizinischen Behandlung abhängig von den verschiedenen therapeutischen Möglichkeiten ist, können auch Stimulationsprotokolle, Ovulationsinduktion, Progesteronunterstützung in der Lutealphase, Embryotransferprotokolle (Furchungsstadien versus Blastozystenstadium/Transfer frischer oder gefrorener Embryonen) und sogar die Wahl des Transferkatheters den Prozess der Implantation beeinflussen. RIF ist somit mehr als nur der Fokus auf den Prozess der eigentlichen Implantation. Den vielversprechendsten Ansatz im Umgang mit RIF bietet die personalisierte Medizin, welche mit einer umfassenden Anamnese und maßgeschneiderten IVF-Protokollen spezifisch für das Patientenpaar alle potenziellen Implantationsstörfaktoren ausschließen kann.
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Metadaten
Titel
Klinische Aspekte des Implantationsversagens
verfasst von
Dr. scient. med. Gregor Weiss, M.Sc.
PD Dr. med. univ. Michael Schenk
Publikationsdatum
22.07.2022
Verlag
Springer Vienna
Erschienen in
Gynäkologie in der Praxis / Ausgabe 4/2022
Print ISSN: 3005-0758
Elektronische ISSN: 3005-0766
DOI
https://doi.org/10.1007/s41974-022-00233-y

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