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DOI: 10.1055/a-1017-3389
Diagnosis and Therapy Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015-085, February 2019) – Part 1, Basic Assessment of the Woman
Artikel in mehreren Sprachen: English | deutschPublikationsverlauf
received 19. September 2019
accepted 23. September 2019
Publikationsdatum:
11. Dezember 2019 (online)
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Abstract
Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German/Austrian/Swiss interdisciplinary S2k guideline on “Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)” was published in February 2019. This guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG).
Aims One third of the causes of involuntary childlessness are still unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. At present, there is no standard treatment concept, as currently no standard multidisciplinary procedures exist for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnostic workup and treatment.
Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process.
Recommendations The first part of this guideline focuses on the basic assessment of affected women, including standard anatomical and endocrinological diagnostic procedures and examinations into any potential infections. Other areas addressed in this guideline are the immunological workup with an evaluation of the patientʼs vaccination status, an evaluation of psychological factors, and the collection of data relating to other relevant factors affecting infertility. The second part will focus on explanations of diagnostic procedures compiled in collaboration with specialists from other medical specialties such as andrologists, human geneticists and oncologists.
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References/Literatur
- 1 Acién P, Acién M, Sánchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod 2004; 19: 2377-2384
- 2 Mehrani T, Petri M. Antiphospholipid Syndrome in systemic autoimmune Diseases. In: Cervera R, Reverter JC, Khamashta M. eds. Handbook of systemic autoimmune Diseases Vol. 10. Amsterdam, Netherlands: Elsevier; 2009: 13-34
- 3 Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM. et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; (10) CD011701
- 4 Anonymous Beschluss der Bundesärztekammer über die Richtlinie zur Entnahme und Übertragung von menschlichen Keimzellen im Rahmen der assistierten Reproduktion. Dtsch Arztebl 2018; 115: A-1096/B-922/C-918
- 5 Anonymous Current clinical irrelevance of luteal phase deficiency: a committee opinion. Fertil Steril 2015; 103: e27-e32
- 6 Anonymous Gesetz über Qualität und Sicherheit von menschlichen Geweben und Zellen (Gewebegesetz), ausgegeben am 27.07.2007. Bundesgesetzblatt 2007 Teil I Nr. 35.
- 7 Anonymous Richtlinie des Gemeinsamen Bundesausschusses zur Empfängnisregelung und zum Schwangerschaftsabbruch, zuletzt geändert am 21. April 2016, veröffentlicht im Bundesanzeiger AT 28.06.2016 B1, in Kraft getreten am 29. Juni 2016. Bundesanzeiger AT 2016.
- 8 Anonymous Richtlinien des Bundesausschusses der Ärzte und Krankenkassen über ärztliche Maßnahmen zur künstlichen Befruchtung („Richtlinien über künstliche Befruchtung“), zuletzt geändert am 16. März 2017 veröffentlicht im Bundesanzeiger BAnz AT 01.06.2017 B4. in Kraft getreten am 2. Juni 2017. Bundesanzeiger BAnz AT 2017.
- 9 Biggioggero M, Meroni PL. The geoepidemiology of the antiphospholipid antibody syndrome. Autoimmun Rev 2010; 9: A299-A304
- 10 Gonik B, Fasano N, Foster S. The obstetrician-gynecologistʼs role in adult immunization. Am J Obstet Gynecol 2002; 187: 984-988
- 11 Gordon CM, Ackerman KE, Berga SL. et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102: 1413-1439
- 12 Grimbizis GF, Di Spiezio Sardo A, Saravelos SH. et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 2016; 31: 2-7
- 13 National Collaborating Centre for Womenʼs and Childrenʼs Health (UK). Fertility: assessment and treatment for people with fertility problems. London: Royal College of Obstetricians and Gynaecologists; 2013
- 14 Keller-Stanislawski B, Englund JA, Kang G. et al. Safety of immunization during pregnancy: a review of the evidence of selected inactivated and live attenuated vaccines. Vaccine 2014; 32: 7057-7064
- 15 Miyakis S, Lockshin MD, Atsumi T. et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4: 295-306
- 16 Moran LJ, Hutchison SK, Norman RJ. et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; (02) CD007506
- 17 Munoz FM, Englund JA. Vaccines in pregnancy. Infect Dis Clin North Am 2001; 15: 253-271
- 18 OʼFlynn N. Assessment and treatment for people with fertility problems: NICE guideline. Br J Gen Pract 2014; 64: 50-51
- 19 Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev 2009; (03) CD006055
- 20 Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 2013; 99: 63
- 21 Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2015; 103: e44-e50
- 22 Monif GRG, Baker DA. Infectious Diseases in Obstetrics and Gynecology. Abingdon: Taylor and Francis; 2004
- 23 Deatsman S, Vasilopoulos T, Rhoton-Vlasak A. Age and Fertility: A Study on Patient Awareness. JBRA Assist Reprod 2016; 20: 99-106
- 24 Wilson WA. Estimates of the US prevalence of systemic lupus erythematosus: Comment on the article by Lawrence et al. Arthritis Rheum 1999; 42: 396